Healthcare Provider Details

I. General information

NPI: 1467729806
Provider Name (Legal Business Name): ERIC BOSSI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 W CHARLESTON BLVD
LAS VEGAS NV
89146-1126
US

IV. Provider business mailing address

1670 UPHAM DR STE 130
COLUMBUS OH
43210-1250
US

V. Phone/Fax

Practice location:
  • Phone: 702-486-8918
  • Fax:
Mailing address:
  • Phone: 614-293-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number17577
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: