Healthcare Provider Details

I. General information

NPI: 1548267032
Provider Name (Legal Business Name): KERRIE ROCHELLE BOSSARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 01/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 DEBARR RD SUITE 280
ANCHORAGE AK
99508-2952
US

IV. Provider business mailing address

2751 DEBARR RD SUITE 280
ANCHORAGE AK
99508-2952
US

V. Phone/Fax

Practice location:
  • Phone: 907-222-1401
  • Fax: 907-222-1402
Mailing address:
  • Phone: 907-222-1401
  • Fax: 907-222-1402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35946
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number26798
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number8070
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: