Provider Demographics
NPI:1881106573
Name:BRANDON E. BOGGS, M.D. INC.
Entity type:Organization
Organization Name:BRANDON E. BOGGS, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BOGGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-233-9038
Mailing Address - Street 1:388 E YOSEMITE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-8219
Mailing Address - Country:US
Mailing Address - Phone:209-233-9038
Mailing Address - Fax:209-580-4741
Practice Address - Street 1:388 E YOSEMITE AVE STE 200
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8219
Practice Address - Country:US
Practice Address - Phone:209-233-9038
Practice Address - Fax:209-580-4741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77822261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care