Healthcare Provider Details

I. General information

NPI: 1417952318
Provider Name (Legal Business Name): PORTLAND FOOT & ANKLE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 MARGINAL WAY 4TH FLOOR
PORTLAND ME
04101
US

IV. Provider business mailing address

68 MARGINAL WAY 4TH FLOOR
PORTLAND ME
04101
US

V. Phone/Fax

Practice location:
  • Phone: 207-879-1339
  • Fax: 207-879-1092
Mailing address:
  • Phone: 207-879-1339
  • Fax: 207-879-1092

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: MR. ROBERT SCOTT JURIS
Title or Position: PHYSICIAN/OWNER
Credential: DPM
Phone: 207-879-1339