Healthcare Provider Details

I. General information

NPI: 1760570006
Provider Name (Legal Business Name): JOHN L. TOOTHAKER, DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 GROVE ST
NEWPORT ME
04953-3347
US

IV. Provider business mailing address

168 GROVE ST
NEWPORT ME
04953-3347
US

V. Phone/Fax

Practice location:
  • Phone: 207-368-5415
  • Fax: 207-368-5415
Mailing address:
  • Phone: 207-368-5415
  • Fax: 207-368-5415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPOD141
License Number StateME

VIII. Authorized Official

Name: JOHN L TOOTHAKER
Title or Position: PRESIDENT
Credential: DPM
Phone: 207-368-5415