| Doctor Name: | MR. MICHAEL DAHYL BOGGAN |
| NPI Number: | 1003844812 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 0101246769 |
| Business Practice Address: | 111 W Stone Dr Suite 100 Kingsport, TN - 376606027 |
| Business Phone Number: | 4232475197 |
| Business Fax Number: | 4232475254 |
| Mailing Address: | 111 W Stone Dr, Suite 100 KINGSPORT |
| State: | TN |
| Postal Code: | 376606027 |
| Phone Number: | 4232455197 |
| Fax Number: | 4232475254 |
| NPI Enumeration Date: | 06/29/2006 |
| NPI Last Update Date: | 08/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 0101246769 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |