MEDICARE: DR. JERICHO P BORJA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	38752	TN
2	207P00000X	Emergency Medicine Physician	MD0000038752	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	610401661	OTHER	TN	HUMANA/TRICARE
3	32312	OTHER	TN	TLC
4	156565	OTHER	TN	BETTER HEALTH
5	4091992	OTHER	TN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1457355349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERICHO P BORJA MD

Provider Business Mailing Address
First Line	:	1812 SAINT ANSELM LN
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-8565
Country	:	US
Telephone Number	:	865-766-5260
Fax Number	:	865-766-5260

Provider Business Practice Location Address
First Line	:	1812 SAINT ANSELM LN
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-8565
Country	:	US
Telephone Number	:	865-766-5260
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	05/30/2012

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Directions to “ DR. JERICHO P BORJA MD” Practice Location

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