Individual
MR. BOGALE JIMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13861 HULL STREET RD, MIDLOTHIAN, VA 23112-2091
(804) 739-0910
(804) 739-2763
Mailing address
13861 HULL STREET RD, MIDLOTHIAN, VA 23112-2091
(804) 739-0910
(804) 739-2763
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101057119
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
541717999
TAX ID
VA
05
—
5631408
—
VA
Enumeration date
09/15/2005
Last updated
01/20/2022
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