Organization
GARY BOGGUS MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STEPHANIE P HARPER (OFFICE MANAGER)
(757) 461-3313
Entity
Organization
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
174400000X
Specialist
Primary
0101050420
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1932290988
—
VA
Enumeration date
07/14/2016
Last updated
07/14/2016
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