Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 1567 | WV |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 1567 | WV |
NPI | 1255310249 |
---|---|
Provider Name | Dr. Darrell K. Boggess |
First Address | Charleston, WV 25311-1824 |
Second Address | Charleston, WV 25311-1824 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 28/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001719575 | BLUE CROSS BLUE SHIELD (01) | |
0055315000 | (05) | WV |
5064588 | AETNA (01) | |
G76284 | (02) |