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General NPI Number Information
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NPI Number | 1053835827
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Entity Type | Organization
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Legal Business Name | PRIME FOOT AND ANKLE, LLC
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Dates
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Enumeration Date | 08/02/2017
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Last Update Date | 08/02/2017
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Provider Practice Location Address
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Address Line | 817 MERRIMACK ST
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City | LOWELL
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State | MA
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Zip | 01854-3571
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Country | US
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Telephone | 508-667-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 817 MERRIMACK ST
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City | LOWELL
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State | MA
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Zip | 01854-3571
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DPM
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Name | PAUL GEORGES
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Credential |
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Telephone | 508-667-8200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 2439
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 2439
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 2439
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License Number State | MA
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