Provider Demographics
NPI:1891752564
Name:CAUTHON, JOHN JEFFERY (DPM)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JEFFERY
Last Name:CAUTHON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 JANICE DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-5777
Mailing Address - Country:US
Mailing Address - Phone:615-785-2803
Mailing Address - Fax:615-777-3450
Practice Address - Street 1:120 JANICE DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-5777
Practice Address - Country:US
Practice Address - Phone:615-785-2803
Practice Address - Fax:615-777-3450
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM601213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3353699Medicaid
TN3353699Medicaid
TN4623440001Medicare NSC
TN3353690Medicare PIN