Individual
GARY WALKER BOGGUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6353 CENTER DR, SUITE 204, NORFOLK, VA 23502-4112
(757) 461-3313
(757) 461-8363
Mailing address
6353 CENTER DR, SUITE 204, NORFOLK, VA 23502-4112
(757) 461-3313
(757) 461-8363
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
0101050420
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007115920
—
VA
01
—
189521
ANTHEM BCBS
VA
01
—
O84416
SENTARA/OPTIMA
VA
Enumeration date
09/27/2006
Last updated
07/22/2016
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