Individual
GERALD BOSSERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
126 E MAIN ST, SUITE D, PAYSON, AZ 85541-5488
(928) 472-5260
Mailing address
126 E MAIN ST, SUITE D, PAYSON, AZ 85541-5488
(928) 472-5260
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1897
AZ
363A00000X
Physician Assistant
1897
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
347220
—
AZ
Enumeration date
07/18/2005
Last updated
09/27/2007
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