Provider Demographics
NPI:1497956148
Name:BOROUGHS, JON BROOKS (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:BROOKS
Last Name:BOROUGHS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4976 ALPHA LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5470
Mailing Address - Country:US
Mailing Address - Phone:423-497-5355
Mailing Address - Fax:423-308-0281
Practice Address - Street 1:1039 EXECUTIVE DR STE 101
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-7900
Practice Address - Country:US
Practice Address - Phone:423-874-0125
Practice Address - Fax:423-874-0154
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45939208000000X
TN6969134208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics