Provider Demographics
NPI:1487601977
Name:CLOUTIER, JAMES J (DPM)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:CLOUTIER
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 1:919 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-1457
Mailing Address - Country:US
Mailing Address - Phone:401-766-4444
Mailing Address - Fax:401-765-4445
Practice Address - Street 1:919 DIAMOND HILL RD
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-1457
Practice Address - Country:US
Practice Address - Phone:401-766-4444
Practice Address - Fax:401-765-4445
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI270213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9007064Medicaid
RI480033470OtherRAILROAD
RIU39446Medicare UPIN
RI0948830001Medicare NSC
RI489007064Medicare PIN