Healthcare Provider Details

I. General information

NPI: 1194799676
Provider Name (Legal Business Name): JOHN C TAPP M.D, F.A.A.F.P, CCD,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 OLD MORGANTOWN ROAD
BOWLING GREEN KY
42101-2842
US

IV. Provider business mailing address

414 OLD MORGANTOWN ROAD
BOWLING GREEN KY
42101-2842
US

V. Phone/Fax

Practice location:
  • Phone: 270-781-1483
  • Fax: 270-781-5101
Mailing address:
  • Phone: 270-781-1483
  • Fax: 270-781-5101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14523/DEA#AT3037252
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAT3037252
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: