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General NPI Number Information
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NPI Number | 1881901627
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Entity Type | Organization
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Legal Business Name | JOHN S BOGGS MD PA
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Dates
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Enumeration Date | 08/31/2010
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Last Update Date | 08/31/2010
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Provider Practice Location Address
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Address Line | 1820 BARRS ST SUITE 104
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4742
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Country | US
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Telephone | 904-388-5391
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Fax | 904-387-8654
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Provider Business Mailing Address
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Address Line | 1820 BARRS ST SUITE 104
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4742
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Country | US
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Telephone | 904-388-5391
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Fax | 904-387-8654
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN S BOGGS
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Credential | MD
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Telephone | 904-388-5391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | ME20523
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License Number State | FL
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