Provider Demographics
NPI:1912310442
Name:FOOTE, CHRISTOPHER CHARLES (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:CHARLES
Last Name:FOOTE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7653
Mailing Address - Country:US
Mailing Address - Phone:207-330-7460
Mailing Address - Fax:
Practice Address - Street 1:10 HIGH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7653
Practice Address - Country:US
Practice Address - Phone:207-330-7460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC82201208800000X
PAOT015640390200000X
MEDO3032208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program