MEDICARE: HARRY R BOFFMAN JR.

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	207X00000X	Orthopaedic Surgery Physician	G258220	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437181989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARRY R BOFFMAN JR.

Provider Business Mailing Address
First Line	:	655 EUCLID AVE
Second Line	:	SUITE 301
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-2957
Country	:	US
Telephone Number	:	619-267-3020
Fax Number	:	619-267-4042

Provider Business Practice Location Address
First Line	:	655 EUCLID AVE
Second Line	:	SUITE 301
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-2957
Country	:	US
Telephone Number	:	619-267-3020
Fax Number	:	619-267-4042

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	09/29/2015

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