Healthcare Provider Details

I. General information

NPI: 1922152024
Provider Name (Legal Business Name): BLUE MOUNTAIN FOOT SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 SW DORION AVE
PENDLETON OR
97801-2086
US

IV. Provider business mailing address

714 SW DORION AVE
PENDLETON OR
97801-2086
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-2372
  • Fax:
Mailing address:
  • Phone: 541-276-2372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberDP00295
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberDP00171
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberDP00357
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDP00295
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDP00357
License Number StateOR
# 6
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDP00171
License Number StateOR

VIII. Authorized Official

Name: DR. DANIEL F BYRD
Title or Position: OWNER
Credential: DPM
Phone: 541-276-2372