Individual
DR. JOLEE BOSTICK RUTHERFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 W POPLAR AVE, COLLIERVILLE, TN 38017-0601
(901) 861-9000
Mailing address
PO BOX 634706, CINCINNATI, OH 45263-0001
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
14653
MS
207P00000X
Emergency Medicine Physician
Primary
27409
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00125126
—
MS
05
—
3837440
—
TN
01
—
4028377
BLUE CROSS
TN
Enumeration date
06/08/2006
Last updated
11/30/2007
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