Provider Demographics
NPI:1669567962
Name:BOGUE, JOHN C (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:BOGUE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19 VILLAGE PLAZA WAY
Mailing Address - Street 2:
Mailing Address - City:N. SCITUATE
Mailing Address - State:RI
Mailing Address - Zip Code:02857
Mailing Address - Country:US
Mailing Address - Phone:401-934-2600
Mailing Address - Fax:401-934-3563
Practice Address - Street 1:19 VILLAGE PLAZA WAY
Practice Address - Street 2:
Practice Address - City:N. SCITUATE
Practice Address - State:RI
Practice Address - Zip Code:02857
Practice Address - Country:US
Practice Address - Phone:401-934-2600
Practice Address - Fax:401-934-3563
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI000292213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9002709Medicaid
RI489002709Medicare PIN
RIU69454Medicare UPIN