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General NPI Number Information
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NPI Number | 1134655756
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Entity Type | Individual
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Provider Name | BENJAMIN CHARLES BOSEN DO
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Gender | Male
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Dates
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Enumeration Date | 05/02/2017
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 288 S PARADISE PKWY # 154
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City | GARDEN CITY
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State | UT
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Zip | 84028-7909
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Country | US
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Telephone | 435-255-1630
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Fax | 435-946-9124
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Provider Business Mailing Address
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Address Line | 221 W 1ST ST
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City | SAINT FRANCIS
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State | KS
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Zip | 67756-3540
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Country | US
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Telephone | 785-332-2682
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 11805306-1204
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 05-44029
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License Number State | KS
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