Healthcare Provider Details

I. General information

NPI: 1003432204
Provider Name (Legal Business Name): FRONTIER FOOT AND ANKLE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 2ND ST SE # 10
BANDON OR
97411-8354
US

IV. Provider business mailing address

780 2ND ST SE # 10
BANDON OR
97411-8354
US

V. Phone/Fax

Practice location:
  • Phone: 971-247-1080
  • Fax: 971-223-3243
Mailing address:
  • Phone: 971-247-1080
  • Fax: 971-223-3243

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: BABAK BAHARLOO
Title or Position: OWNER
Credential:
Phone: 541-329-2555