Healthcare Provider Details

I. General information

NPI: 1992164628
Provider Name (Legal Business Name): MARIN FOOT AND ANKLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2016
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 N KNOLL RD STE 3
MILL VALLEY CA
94941-1665
US

IV. Provider business mailing address

7 N KNOLL RD STE 3
MILL VALLEY CA
94941-1665
US

V. Phone/Fax

Practice location:
  • Phone: 415-388-2777
  • Fax: 415-388-2778
Mailing address:
  • Phone: 415-388-2777
  • Fax: 415-388-2778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES BRYAN ROBISON
Title or Position: CEO
Credential: DPM
Phone: 415-388-2777