Individual
JEFFERY COWAN BOSARGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1221 S CLEARVIEW PKWY, JEFFERSON, LA 70121-1011
(228) 342-1440
Mailing address
684 OAHU ST, DIAMONDHEAD, MS 39525-3540
(228) 342-1440
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0350
MS
Other
Enumeration date
11/06/2015
Last updated
11/06/2015
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