Healthcare Provider Details

I. General information

NPI: 1003663949
Provider Name (Legal Business Name): SEACOAST FOOT AND ANKLE CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 SEWALL ST STE 2
PORTLAND ME
04102-2644
US

IV. Provider business mailing address

28 WILDLIFE LN
NORTH YARMOUTH ME
04097-6359
US

V. Phone/Fax

Practice location:
  • Phone: 207-761-3889
  • Fax: 207-761-1874
Mailing address:
  • Phone: 215-990-7274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN JOSEPH HIEBERT
Title or Position: OWNER/DOCTOR
Credential: DPM
Phone: 215-990-7274