Basic Information
| Provider Information | |||||||||
| NPI: | 1003009267 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOSLEY | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | STEVEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 OROTE POINT RD | ||||||||
| Address2: | |||||||||
| City: | SANTA RITA | ||||||||
| State: | GU | ||||||||
| PostalCode: | 969151130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6715649098 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10 OROTE POINT RD | ||||||||
| Address2: | |||||||||
| City: | SANTA RITA | ||||||||
| State: | GU | ||||||||
| PostalCode: | 969151130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6715649098 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2007 | ||||||||
| LastUpdateDate: | 08/21/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1710I1002X | Y | Other Service Providers | Military Health Care Provider | Independent Duty Corpsman |
No ID Information.