MEDICARE: DEBRA ANNE BOGOSSIAN MD

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
1	207R00000X	Internal Medicine Physician	N8378	TX

General Provider Information

NPI Number	:	1437175064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA ANNE BOGOSSIAN MD

Provider Business Mailing Address
First Line	:	11880 VISTA DEL SOL DR
Second Line	:	SUITE B
City	:	EL PASO
State	:	TX
Zip	:	79936-6128
Country	:	US
Telephone Number	:	915-857-6699
Fax Number	:	915-856-7268

Provider Business Practice Location Address
First Line	:	11880 VISTA DEL SOL DR
Second Line	:	SUITE B
City	:	EL PASO
State	:	TX
Zip	:	79936-6128
Country	:	US
Telephone Number	:	915-857-6699
Fax Number	:	915-856-7268

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	06/12/2014

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