Individual
DR. THOMAS FRANCIS BODUCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
314 E SPRING ST, KINGSTON, TN 37763-2839
(865) 376-1212
(865) 376-0010
Mailing address
PO BOX 1030, KINGSTON, TN 37763-1030
(865) 376-1212
(865) 376-0010
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
14330
TN
208D00000X
General Practice Physician
Primary
MD0000014330
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0086951
BLUECROSS BLUESHIELD OF TENNESSEE
TN
05
—
3004412
—
TN
Enumeration date
06/16/2005
Last updated
01/10/2012
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