NPIMap

Organization Active NPI

Brockton Podiatry Group a Prof Corp

  • Foot & Ankle Surgery Podiatrist
  • Redlands, CA
National Provider Identifier
1275867228
Registry record updated Mar 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
E1514 Issued in CA
Legal business name
BROCKTON PODIATRY GROUP A PROF CORP
Practice address
16 E Fern Ave
Suite B
Redlands, CA 92373-4000
Phone
(909) 793-2379
Fax
(909) 793-9660
NPI assigned
Sep 23, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael N Durrant, DPM MPH
Title
Physician/Owner
Phone
(909) 793-2379

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X E1514 CA Primary

Addresses

Primary practice location

16 E Fern Ave
Suite B
Redlands, CA 92373-4000

Mailing address

16 E Fern Ave
Suite B
Redlands, CA 92373-4000
Phone (909) 793-2379

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 34

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1253664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300752000000",
    "number": "1275867228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 E FERN AVE",
            "address_2": "SUITE B",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923734000",
            "telephone_number": "909-793-2379",
            "fax_number": "909-793-9660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 E FERN AVE",
            "address_2": "SUITE B",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923734000",
            "telephone_number": "909-793-2379",
            "fax_number": "909-793-9660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROCKTON PODIATRY GROUP A PROF CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-23",
        "last_updated": "2011-03-22",
        "status": "A",
        "authorized_official_last_name": "DURRANT",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "909-793-2379",
        "authorized_official_credential": "DPM MPH"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CA",
            "license": "E1514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redlands, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.