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NPI Code Detail

MEDICARE: DONALD E BOGARD II PA-C

MEDICARE: DONALD E BOGARD II PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician Assistant50-00-0768OH
2363A00000XPhysician Assistant50-000768OH

General Provider Information

NPI Number : 1336140896
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONALD E BOGARD II PA-C
Provider Business Mailing Address
First Line : 6680 POE AVE
Second Line : SUITE 200
City : DAYTON
State : OH
Zip : 45414-2854
Country : US
Telephone Number : 937-280-8400
Fax Number : 937-280-8373
Provider Business Practice Location Address
First Line : 2350 MIAMI VALLEY DR STE 500
Second Line :
City : CENTERVILLE
State : OH
Zip : 45459-4780
Country : US
Telephone Number : 937-425-0003
Fax Number : 937-245-6308
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 12/29/2020

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Directions to “ DONALD E BOGARD II PA-C” Practice Location

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