Healthcare Provider Details

I. General information

NPI: 1467448464
Provider Name (Legal Business Name): PAUL C QUIGLEY JR. DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 ELM ST
SOUTHBRIDGE MA
01550-2640
US

IV. Provider business mailing address

122 ELM ST
SOUTHBRIDGE MA
01550-2640
US

V. Phone/Fax

Practice location:
  • Phone: 508-764-8175
  • Fax: 508-764-6434
Mailing address:
  • Phone: 508-764-8175
  • Fax: 508-764-6434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1626
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: