Individual
LOUIS A MODICA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
BUILDING #8 DOGWOOD AVE, VAMC, MOUNTAIN HOME, TN 37684-6062
(423) 439-7201
(423) 439-7219
Mailing address
PO BOX 699, MOUNTAIN HOME, TN 37684-0699
(423) 433-6039
(423) 433-6060
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD15612
TN
Other
Enumeration date
09/16/2005
Last updated
02/03/2011
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