MEDICARE: GEORGE DAVID BOJRAB 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	208VP0014X	Interventional Pain Medicine Physician	01040336A	IN
2	367500000X	Certified Registered Nurse Anesthetist	01040336A	IN

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	:	1891768537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE DAVID BOJRAB MD

Provider Business Mailing Address
First Line	:	10228 DUPONT CIRCLE DR EAST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825
Country	:	US
Telephone Number	:	260-490-2525
Fax Number	:	260-490-7254

Provider Business Practice Location Address
First Line	:	10228 DUPONT CIRCLE DR E
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1611
Country	:	US
Telephone Number	:	260-490-2525
Fax Number	:	260-490-7254

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	08/08/2016

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