Individual
BRENT JERROD BOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
842 E MAIN ST, MEDFORD, OR 97504-7134
(541) 618-5800
(541) 779-3027
Mailing address
842 E MAIN ST, MEDFORD, OR 97504-7134
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
15785
NH
2085R0204X
Vascular & Interventional Radiology Physician
Primary
MD161662
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500657645
—
OR
01
—
R170676
MEDICARE
—
Enumeration date
12/03/2008
Last updated
01/31/2023
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