Healthcare Provider Details

I. General information

NPI: 1962803940
Provider Name (Legal Business Name): ROBERT TAYLOR DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 FOREST AVE SUITE 303
PORTLAND ME
04103-1889
US

IV. Provider business mailing address

1250 FOREST AVE SUITE 303
PORTLAND ME
04103-1889
US

V. Phone/Fax

Practice location:
  • Phone: 207-772-8962
  • Fax: 207-775-0161
Mailing address:
  • Phone: 207-772-8962
  • Fax: 207-775-0161

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: ROBERT BRIAN TAYLOR
Title or Position: OWNER
Credential: DPM
Phone: 207-772-8962