Healthcare Provider Details

I. General information

NPI: 1649448804
Provider Name (Legal Business Name): EUGENE PODIATRY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 CHAMBERS ST.
EUGENE OR
97402
US

IV. Provider business mailing address

1060 CHAMBERS ST.
EUGENE OR
97402
US

V. Phone/Fax

Practice location:
  • Phone: 541-342-3373
  • Fax: 541-342-3374
Mailing address:
  • Phone: 541-342-3373
  • Fax: 541-342-3374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberDP00142
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT W ROBERTSON
Title or Position: DOCTOR
Credential: DPM
Phone: 541-342-3373