Provider Demographics
NPI:1790864486
Name:PADULA, JOHN PATRICK (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PATRICK
Last Name:PADULA
Suffix:
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:PO BOX 7031
Mailing Address - Street 2:
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-7031
Mailing Address - Country:US
Mailing Address - Phone:256-413-0093
Mailing Address - Fax:256-413-0096
Practice Address - Street 1:107 CHURCH ST
Practice Address - Street 2:
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-6242
Practice Address - Country:US
Practice Address - Phone:256-413-0093
Practice Address - Fax:256-413-0096
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL159213E00000X
AL000159213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000054952Medicaid
AL51054952OtherBCBS
AL000054952Medicaid
AL51054952OtherBCBS