Individual
PAUL THURDEKOOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3 PROFESSIONAL PARK DR, SUITE 31, JOHNSON CITY, TN 37604-6529
(423) 975-5650
(423) 975-5652
Mailing address
3 PROFESSIONAL PARK DR, SUITE 31, JOHNSON CITY, TN 37604-6529
(423) 975-5650
(423) 975-5652
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD12981
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3184779
—
TN
Enumeration date
09/23/2005
Last updated
06/06/2012
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