Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 00014196 | AL |
NPI | 1134187271 |
---|---|
Provider Name | Dr. William Joseph Bose |
First Address | Mobile, AL 36608-6705 |
Second Address | Mobile, AL 36608-6705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 18/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
511-01345 | BLUE CROSS OF AL (01) | AL |
C75316 | (02) |