Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | G33967 | CA |
Y | 111NI0900X | Internist | G33967 | CA |
N | 207RG0300X | Geriatric Medicine | G33967 | CA |
NPI | 1053346080 |
---|---|
Provider Name | Dr. Gerard Boss |
First Address | San Diego, CA 92193-2410 |
Second Address | San Diego, CA 92103-9001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 03/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G339670 | (05) | CA |
A45742 | (02) | CA |