MEDICARE: JAMES RUSSELL THURMAN DDS

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DS4683	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0093618	OTHER	TN	BCBS

General Provider Information

NPI Number	:	1598781528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES RUSSELL THURMAN DDS

Provider Business Mailing Address
First Line	:	2120 NORTH JACKSON STREET
Second Line	:
City	:	TULLAHOMA
State	:	TN
Zip	:	37388-2208
Country	:	US
Telephone Number	:	931-455-6020
Fax Number	:	931-454-9694

Provider Business Practice Location Address
First Line	:	2120 NORTH JACKSON STREET
Second Line	:
City	:	TULLAHOMA
State	:	TN
Zip	:	37388-2208
Country	:	US
Telephone Number	:	931-455-6020
Fax Number	:	931-454-9694

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	03/25/2011

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