Provider Demographics
NPI:1104982453
Name:BOVINE, THOMAS P (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:BOVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7794 RHEA COUNTY HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-5981
Mailing Address - Country:US
Mailing Address - Phone:423-775-3363
Mailing Address - Fax:423-775-3366
Practice Address - Street 1:7794 RHEA COUNTY HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-5981
Practice Address - Country:US
Practice Address - Phone:423-775-3363
Practice Address - Fax:423-775-3366
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2014-01-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD14692207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3199194Medicaid
TN3199194Medicare ID - Type Unspecified
TNBO4839Medicare UPIN