Healthcare Provider Details

I. General information

NPI: 1295476422
Provider Name (Legal Business Name): DAVID BOSCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2022
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 38TH AVE N
ST PETERSBURG FL
33710-1629
US

IV. Provider business mailing address

89 E 200 S UNIT 1610
SALT LAKE CITY UT
84111-2281
US

V. Phone/Fax

Practice location:
  • Phone: 727-384-7727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number14210097-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: