Healthcare Provider Details

I. General information

NPI: 1730142340
Provider Name (Legal Business Name): TODD PATRICK BOREN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 CENTRAL AVE
CHATTANOOGA TN
37403-1503
US

IV. Provider business mailing address

26 MOUNTAIN ORCHARD PATH
SIGNAL MOUNTAIN TN
37377-2663
US

V. Phone/Fax

Practice location:
  • Phone: 727-385-4644
  • Fax:
Mailing address:
  • Phone: 727-385-4644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME90652
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: