Provider Demographics
NPI:1043472269
Name:DEMOINY, SEBASTIEN GABRIEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:SEBASTIEN
Middle Name:GABRIEL
Last Name:DEMOINY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:420 W MORRIS BLVD
Mailing Address - Street 2:SUITE 400D
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2283
Mailing Address - Country:US
Mailing Address - Phone:423-586-7509
Mailing Address - Fax:423-581-5701
Practice Address - Street 1:420 W MORRIS BLVD
Practice Address - Street 2:SUITE 400D
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2283
Practice Address - Country:US
Practice Address - Phone:423-586-7509
Practice Address - Fax:423-581-5701
Is Sole Proprietor?:No
Enumeration Date:2008-06-29
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN703213E00000X, 213ES0103X
PASC005923213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDPM703OtherSTATE LICENSE
PASC005923OtherSTATE LICENSE
TN1520364Medicaid
103I482100Medicare PIN