Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 55647 | TN |
N | 207RG0100X | Gastroenterologist | 77562 | GA |
NPI | 1013215078 |
---|---|
Provider Name | Dr. Charles Robert Bosshardt |
First Address | Hixson, TN 37343-5470 |
Second Address | Chattanooga, TN 37404-1100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2011 |
Last Update Date | 18/02/2021 |