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General NPI Number Information
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NPI Number | 1760570006
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Entity Type | Organization
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Legal Business Name | JOHN L. TOOTHAKER, DPM PA
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 168 GROVE ST
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City | NEWPORT
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State | ME
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Zip | 04953-3347
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Country | US
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Telephone | 207-368-5415
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Fax | 207-368-5415
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Provider Business Mailing Address
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Address Line | 168 GROVE ST
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City | NEWPORT
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State | ME
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Zip | 04953-3347
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Country | US
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Telephone | 207-368-5415
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Fax | 207-368-5415
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN L TOOTHAKER
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Credential | DPM
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Telephone | 207-368-5415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | POD141
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License Number State | ME
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