Provider Demographics
NPI:1629033758
Name:SOMERS, PAUL JOSEPH JR (DPM)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JOSEPH
Last Name:SOMERS
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 1:311 WHITE BRIDGE PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-3208
Mailing Address - Country:US
Mailing Address - Phone:615-356-3249
Mailing Address - Fax:615-356-3254
Practice Address - Street 1:311 WHITE BRIDGE PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-3208
Practice Address - Country:US
Practice Address - Phone:615-356-3249
Practice Address - Fax:615-356-3254
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM0000000199213E00000X
IN07000408A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3350766Medicare ID - Type Unspecified
TN3350767Medicare ID - Type Unspecified
TNT61073Medicare UPIN