MEDICARE: DR. THOMAS BOSCH PHD, RDN, LDN

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	133N00000X	Nutritionist	10177915	OR
2	133NN1002X	Nutrition Education Nutritionist	10177915	OR
3	133V00000X	Registered Dietitian	10177915	OR

General Provider Information

NPI Number	:	1972056562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS BOSCH PHD, RDN, LDN

Provider Business Mailing Address
First Line	:	2455 FIELDCRESS RD
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97403-3255
Country	:	US
Telephone Number	:	541-505-7758
Fax Number	:	541-505-7758

Provider Business Practice Location Address
First Line	:	2455 FIELDCRESS RD
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97403-3255
Country	:	US
Telephone Number	:	541-505-7758
Fax Number	:	541-505-7758

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

Provider Enumeration Date	:	07/29/2016
Last Update Date	:	07/29/2016

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