MEDICARE: DR. JOSEPH RICHARD BOSARGE M.D.

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	ME94065	FL
2	207R00000X	Internal Medicine Physician	19863	MS
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	19863	MS
4	207RP1001X	Pulmonary Disease Physician	19863	MS

General Provider Information

NPI Number	:	1760465058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH RICHARD BOSARGE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1810
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39502
Country	:	US
Telephone Number	:	228-575-1194
Fax Number	:	228-575-2917

Provider Business Practice Location Address
First Line	:	1340 BROAD AVE
Second Line	:	SUITE 320
City	:	GULFPORT
State	:	MS
Zip	:	39501-2404
Country	:	US
Telephone Number	:	228-575-1775
Fax Number	:

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	09/14/2023

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