Provider Demographics
NPI:1417953332
Name:BOES, THOMAS J (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:BOES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 OLENTANGY RIVER RD
Mailing Address - Street 2:STE 201
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3907
Mailing Address - Country:US
Mailing Address - Phone:614-267-8585
Mailing Address - Fax:614-267-9793
Practice Address - Street 1:3545 OLENTANGY RIVER RD
Practice Address - Street 2:STE 201
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3907
Practice Address - Country:US
Practice Address - Phone:614-267-8585
Practice Address - Fax:614-267-9793
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4880094OtherUHC
OH0674668Medicaid
OH2211181-009OtherCIGNA
OH311906786212OtherBC/BS
OHBO0641161Medicare ID - Type UnspecifiedPROVIDER #
OH0674668Medicaid