TIMOTHY GEORGE DUTRA DPM NPI 1588650162

NPI Information

Timothy George Dutra, DPM is a foot and ankle surgery orthopaedic surgery in San Leandro, CA. The provider is recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, foot and ankle surgeons deal with adult reconstructive foot and ankle surgery, adult foot and ankle trauma, sports medicine foot and ankle, and children's foot and ankle reconstructive surgery. Timothy George Dutra, DPM NPI is 1588650162. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

13847 E 14TH ST
#110A
SAN LEANDRO, CA
ZIP 94578-632
Phone: (510) 351-7122
Fax: (510) 351-1797

The NPI 1588650162 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 9/20/2005 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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