Healthcare Provider Details

I. General information

NPI: 1700386992
Provider Name (Legal Business Name): ELITE FOOT & ANKLE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37569 HIGHWAY 26
SANDY OR
97055-9301
US

IV. Provider business mailing address

37569 HIGHWAY 26
SANDY OR
97055-9301
US

V. Phone/Fax

Practice location:
  • Phone: 503-668-5210
  • Fax: 877-480-9759
Mailing address:
  • Phone: 503-668-5210
  • Fax:

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: DR. TREVOR J HAYNES
Title or Position: OWNER/MANAGER
Credential: DPM
Phone: 208-316-7729