Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 44489 | TN |
NPI | 1912973249 |
---|---|
Provider Name | Michael A. Boggess |
First Address | Brentwood, TN 37027-3241 |
Second Address | Brentwood, TN 37027-3241 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 22/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64007750 | (05) | KY |
H13652 | (02) | KY |
Q017030 | (05) | TN |