Provider Demographics
NPI:1457355349
Name:BORJA, JERICHO P (MD)
Entity type:Individual
Prefix:DR
First Name:JERICHO
Middle Name:P
Last Name:BORJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JERICHO
Other - Middle Name:P
Other - Last Name:BORJA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1812 SAINT ANSELM LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-8565
Mailing Address - Country:US
Mailing Address - Phone:865-766-5260
Mailing Address - Fax:865-766-5260
Practice Address - Street 1:1812 SAINT ANSELM LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-8565
Practice Address - Country:US
Practice Address - Phone:865-766-5260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38752207Q00000X
TNMD0000038752207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3897760Medicaid
TN610401661OtherHUMANA/TRICARE
TN32312OtherTLC
TN156565OtherBETTER HEALTH
TN4091992OtherBLUE CROSS BLUE SHIELD
TNI14402Medicare UPIN
TN3897760Medicare ID - Type Unspecified