Healthcare Provider Details

I. General information

NPI: 1235558818
Provider Name (Legal Business Name): JULES BODO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 BRIGHTON AVE STE 103
PORTLAND ME
04102-2373
US

IV. Provider business mailing address

619 BRIGHTON AVE STE 103
PORTLAND ME
04102-2373
US

V. Phone/Fax

Practice location:
  • Phone: 207-910-5454
  • Fax:
Mailing address:
  • Phone: 207-910-5454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number006840
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: