Provider Demographics
NPI:1104079250
Name:MACLEOD, JOHN ALEXANDER (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALEXANDER
Last Name:MACLEOD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:925 RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4436
Mailing Address - Country:US
Mailing Address - Phone:401-714-6997
Mailing Address - Fax:401-942-5986
Practice Address - Street 1:925 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4436
Practice Address - Country:US
Practice Address - Phone:401-714-6997
Practice Address - Fax:401-942-5986
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-01
Last Update Date:2008-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDPM00220213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist