Provider Demographics
NPI:1467448464
Name:QUIGLEY, PAUL C JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:C
Last Name:QUIGLEY
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 ELM ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-2640
Mailing Address - Country:US
Mailing Address - Phone:508-764-8175
Mailing Address - Fax:508-764-6434
Practice Address - Street 1:122 ELM ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-2640
Practice Address - Country:US
Practice Address - Phone:508-764-8175
Practice Address - Fax:508-764-6434
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1626213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0342009Medicaid
MA0342009Medicaid
MAY70682Medicare ID - Type Unspecified