Individual
MR. MICHAEL DAHYL BOGGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 W STONE DR, SUITE 100, KINGSPORT, TN 37660-6027
(423) 247-5197
(423) 247-5254
Mailing address
111 W STONE DR, SUITE 100, KINGSPORT, TN 37660-6027
(423) 245-5197
(423) 247-5254
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
0101246769
VA
208D00000X
General Practice Physician
Primary
21139
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010199743
—
VA
05
—
1000908
—
TN
05
—
3057903
—
TN
01
—
621112685
UNITED HEALTH CARE
TN
05
—
65906208
—
KY
05
—
P00262488
—
KY
01
—
Z101
UNITED HEALTHCARE OF THE RIVER VALLEY
TN
Enumeration date
06/29/2006
Last updated
08/06/2012
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