MEDICARE: DR. PETER S. BOSS 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	207P00000X	Emergency Medicine Physician	G37988	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
2	050618CA47313	OTHER	CA	BEAR VALLEY TRAILBLAZER
3	00G379880	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1780637173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER S. BOSS M.D.

Provider Business Mailing Address
First Line	:	2550 NORTH HOLLYWOOD WAY
Second Line	:	SUITE 209
City	:	BURBANK
State	:	CA
Zip	:	91505-5019
Country	:	US
Telephone Number	:	818-557-0135
Fax Number	:	818-557-1394

Provider Business Practice Location Address
First Line	:	41870 GARSTIN DRIVE
Second Line	:
City	:	BIG BEAR LAKE
State	:	CA
Zip	:	92315-1649
Country	:	US
Telephone Number	:	909-878-8201
Fax Number	:	909-878-8286

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	07/09/2007

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