Individual
LEON JACOB BOGARTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.,
Contact information
Practice address
7540 DANNAHER LN, STE. 300, POWELL, TN 37849-4013
(865) 362-8524
(865) 545-3115
Mailing address
2 WOODSTOCK CT, HILTON HEAD, SC 29928-3385
(843) 842-7875
(843) 842-9545
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0000006741
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2002856
—
TN
Enumeration date
07/04/2006
Last updated
07/08/2007
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