Provider Demographics
NPI:1346008711
Name:PEARL FOOT AND ANKLE LLC
Entity Type:Organization
Organization Name:PEARL FOOT AND ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MINEO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:503-477-0409
Mailing Address - Street 1:3601 NW 115TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-9321
Mailing Address - Country:US
Mailing Address - Phone:503-477-0409
Mailing Address - Fax:
Practice Address - Street 1:12672 NW BARNES RD STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-6191
Practice Address - Country:US
Practice Address - Phone:503-284-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty