Provider Demographics
NPI:1275717050
Name:HIEBERT, RYAN JOSEPH (DPM)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JOSEPH
Last Name:HIEBERT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SEWALL ST STE 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2644
Mailing Address - Country:US
Mailing Address - Phone:207-761-3889
Mailing Address - Fax:207-761-1874
Practice Address - Street 1:51 SEWALL ST STE 2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2644
Practice Address - Country:US
Practice Address - Phone:207-761-3889
Practice Address - Fax:207-761-1874
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD1073213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery