Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 20A6488 | CA |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | OP60924421 | WA |
NPI | 1063426989 |
---|---|
Provider Name | Ross Bogey |
First Address | Spokane, WA 99210-2185 |
Second Address | Spokane, WA 99202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 15/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036109440-1 | (05) | IL |
036109440-2 | (05) | IL |
G69465 | (02) | |
P00101984 | RAILROAD MEDICARE (01) | IL |