Provider Demographics
NPI:1427116300
Name:BEAUPAIN, JIL A (DPM)
Entity type:Individual
Prefix:DR
First Name:JIL
Middle Name:A
Last Name:BEAUPAIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:ME
Mailing Address - Zip Code:04776-0130
Mailing Address - Country:US
Mailing Address - Phone:207-532-9790
Mailing Address - Fax:207-532-6550
Practice Address - Street 1:92 WOODBRIDGE CORNER RD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:ME
Practice Address - Zip Code:04776-3330
Practice Address - Country:US
Practice Address - Phone:207-532-9790
Practice Address - Fax:207-532-6550
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003477L213EP1101X
MEPOD229213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPOD229OtherSTATE OF MAINE
PA0742640001Medicare NSC
PA874929Medicare ID - Type Unspecified