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NPI Code Detail

MEDICARE: PORTLAND FOOT & ANKLE, PA

MEDICARE: PORTLAND FOOT & ANKLE, PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0103XFoot & Ankle Surgery Podiatrist

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
5CH4448OTHERMERAILROAD MEDICARE GROUP

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1480030888OTHERMEK. PAUL FLANIGAN
2CH4448OTHERMEPALMETTO GROUP
30619920001OTHERMEDMERC GROUP
4480023694OTHERMEROBERT S. JURIS

General Provider Information

NPI Number : 1417952318
Entity Type Code : Organization
Provider Name (Legal Business Name) : PORTLAND FOOT & ANKLE, PA
Provider Business Mailing Address
First Line : 68 MARGINAL WAY
Second Line : 4TH FLOOR
City : PORTLAND
State : ME
Zip : 04101
Country : US
Telephone Number : 207-879-1339
Fax Number : 207-879-1092
Provider Business Practice Location Address
First Line : 68 MARGINAL WAY
Second Line : 4TH FLOOR
City : PORTLAND
State : ME
Zip : 04101
Country : US
Telephone Number : 207-879-1339
Fax Number : 207-879-1092
Authorized Official
Title or Position : PHYSICIAN/OWNER
Name : MR. ROBERT SCOTT JURIS
Credential : DPM
Telephone Number : 207-879-1339
Provider Enumeration Date : 06/16/2005
Last Update Date : 03/20/2014

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Directions to “PORTLAND FOOT & ANKLE, PA ” Practice Location

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