MEDICARE: EASTSIDE FOOT AND ANKLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	DP00435	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669884003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTSIDE FOOT AND ANKLE

Provider Business Mailing Address
First Line	:	1827 NE 44TH AVE STE 100
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-1443
Country	:	US
Telephone Number	:	503-284-2000
Fax Number	:	503-284-2002

Provider Business Practice Location Address
First Line	:	1827 NE 44TH AVE STE 100
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-1443
Country	:	US
Telephone Number	:	503-284-2000
Fax Number	:	503-284-2002

Authorized Official
Title or Position	:	PODIATRIST/OWNER
Name	:	DR. BRIAN BOWEN
Credential	:	DPM
Telephone Number	:	503-284-2000

Provider Enumeration Date	:	05/20/2014
Last Update Date	:	12/13/2021

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Directions to “EASTSIDE FOOT AND ANKLE ” Practice Location

Language	Start Address	Practice Location

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