Provider Demographics
NPI:1831285972
Name:MARCOUX, JOHN THOMAS (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
Last Name:MARCOUX
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:11 NEVINS ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3514
Mailing Address - Country:US
Mailing Address - Phone:617-789-2442
Mailing Address - Fax:617-789-4207
Practice Address - Street 1:11 NEVINS ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3514
Practice Address - Country:US
Practice Address - Phone:617-789-2442
Practice Address - Fax:617-789-4207
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2011-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2128213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0316733Medicaid
MA0316733Medicaid
U70731Medicare UPIN