Individual
THEODORE R BOSCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
208 S 14TH ST, MOUNT VERNON, WA 98274-4117
(360) 814-2600
Mailing address
1415 E KINCAID ST, MOUNT VERNON, WA 98274-4126
(360) 428-2500
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
A75333
CA
208600000X
Surgery Physician
Primary
MD61652294
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A753330
BLUE SHIELD
CA
05
—
00A753330
—
CA
Enumeration date
02/22/2007
Last updated
05/21/2026
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