MEDICARE: JOHN S BOGGS MD PA

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	207T00000X	Neurological Surgery Physician	ME20523	FL

General Provider Information

NPI Number	:	1881901627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN S BOGGS MD PA

Provider Business Mailing Address
First Line	:	1820 BARRS ST
Second Line	:	SUITE 104
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4742
Country	:	US
Telephone Number	:	904-388-5391
Fax Number	:	904-387-8654

Provider Business Practice Location Address
First Line	:	1820 BARRS ST
Second Line	:	SUITE 104
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4742
Country	:	US
Telephone Number	:	904-388-5391
Fax Number	:	904-387-8654

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN S BOGGS
Credential	:	MD
Telephone Number	:	904-388-5391

Provider Enumeration Date	:	08/31/2010
Last Update Date	:	08/31/2010

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