Healthcare Provider Details

I. General information

NPI: 1104804756
Provider Name (Legal Business Name): JAMES A. BOESIGER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9327 W SUNSET RD
LAS VEGAS NV
89148-4845
US

IV. Provider business mailing address

2809 W CHARLESTON BLVD STE 150
LAS VEGAS NV
89102-1998
US

V. Phone/Fax

Practice location:
  • Phone: 702-476-9999
  • Fax: 702-946-1343
Mailing address:
  • Phone: 702-476-9999
  • Fax: 702-946-1343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA961
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: