Organization
COASTAL FOOT & ANKLE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN SABOURIN DPM (OWNER)
(508) 258-1717
Entity
Organization
Contact information
Practice address
850 AQUIDNECK AVE, MIDDLETOWN, RI 02842-7280
(401) 849-2157
(401) 848-8441
Mailing address
850 AQUIDNECK AVE, MIDDLETOWN, RI 02842-7280
(401) 849-2157
(401) 848-8441
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
DPM00316
RI
261QM2500X
Medical Specialty Clinic/Center
2210
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FH00185
—
RI
Enumeration date
09/15/2017
Last updated
07/21/2022
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