Provider Demographics
NPI:1174703409
Name:PAUL, MARIE C (DPM)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:C
Last Name:PAUL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13954 W WADDELL RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-8750
Mailing Address - Country:US
Mailing Address - Phone:623-584-0760
Mailing Address - Fax:623-546-0344
Practice Address - Street 1:13954 W WADDELL RD
Practice Address - Street 2:SUITE 307
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-8750
Practice Address - Country:US
Practice Address - Phone:623-584-0760
Practice Address - Fax:623-546-0344
Is Sole Proprietor?:No
Enumeration Date:2007-11-03
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0711213E00000X, 213E00000X
NYN004690-1213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0711OtherSTATE LICENSE
AZ616931Medicaid
AZZ142326Medicare PIN
NYPG5591Medicare PIN