Provider Demographics
NPI:1194799676
Name:TAPP, JOHN C (MD, FAAFP, CCD,)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
Last Name:TAPP
Suffix:
Gender:M
Credentials:MD, FAAFP, CCD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 OLD MORGANTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-2842
Mailing Address - Country:US
Mailing Address - Phone:270-781-1483
Mailing Address - Fax:270-781-5101
Practice Address - Street 1:414 OLD MORGANTOWN ROAD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2842
Practice Address - Country:US
Practice Address - Phone:270-781-1483
Practice Address - Fax:270-781-5101
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14523/DEA#AT3037252207Q00000X
KYAT3037252207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64145238Medicaid
KY0970301OtherMEDICARE ID
KYC71147Medicare UPIN
KY1182001Medicare ID - Type UnspecifiedMEDICARE
KY1182001Medicare PIN