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Organization

SANDY RIVER PODIATRY, PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JEFFREY JOHNSON DPM (OWNER)
(207) 779-1002
Entity
Organization

Contact information

Practice address
114 PERHAM ST, FARMINGTON, ME 04938-1520
(207) 779-1002
(207) 779-1091
Mailing address
114 PERHAM ST, FARMINGTON, ME 04938-1520
(207) 779-1002
(207) 779-1091

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
POD1034
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
134880000
ME
Enumeration date
04/23/2007
Last updated
09/16/2009
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