Provider Demographics
NPI:1972056562
Name:BOSCH, THOMAS (PHD, RDN, LDN)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:BOSCH
Suffix:
Gender:M
Credentials:PHD, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 FIELDCRESS RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-3255
Mailing Address - Country:US
Mailing Address - Phone:541-505-7758
Mailing Address - Fax:541-505-7758
Practice Address - Street 1:2455 FIELDCRESS RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-3255
Practice Address - Country:US
Practice Address - Phone:541-505-7758
Practice Address - Fax:541-505-7758
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10177915133N00000X, 133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education