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General NPI Number Information
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NPI Number | 1679376065
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Entity Type | Organization
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Legal Business Name | MAINE FOOT AND ANKLE SPECIALISTS, PLLC
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 619 BRIGHTON AVE
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City | PORTLAND
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State | ME
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Zip | 04102-2373
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Country | US
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Telephone | 207-521-6107
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Fax |
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Provider Business Mailing Address
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Address Line | 619 BRIGHTON AVE
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City | PORTLAND
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State | ME
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Zip | 04102-2373
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Country | US
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Telephone | 207-910-5454
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Fax |
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Authorized Official
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Title or Position | OWNNER/PHYSICIAN
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Name | JULES B BODO
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Credential | DPM
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Telephone | 207-521-6107
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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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