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General NPI Number Information
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NPI Number | 1417952318
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Entity Type | Organization
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Legal Business Name | PORTLAND FOOT & ANKLE, PA
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 03/20/2014
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Provider Practice Location Address
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Address Line | 68 MARGINAL WAY 4TH FLOOR
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City | PORTLAND
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State | ME
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Zip | 04101
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Country | US
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Telephone | 207-879-1339
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Fax | 207-879-1092
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Provider Business Mailing Address
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Address Line | 68 MARGINAL WAY 4TH FLOOR
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City | PORTLAND
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State | ME
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Zip | 04101
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Country | US
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Telephone | 207-879-1339
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Fax | 207-879-1092
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | MR. ROBERT SCOTT JURIS
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Credential | DPM
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Telephone | 207-879-1339
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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 |
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License Number State |
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