Provider Demographics
NPI:1003009267
Name:BOSLEY, CRAIG STEVEN
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:STEVEN
Last Name:BOSLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 OROTE POINT RD
Mailing Address - Street 2:
Mailing Address - City:SANTA RITA
Mailing Address - State:GU
Mailing Address - Zip Code:96915-1130
Mailing Address - Country:US
Mailing Address - Phone:671-564-9098
Mailing Address - Fax:
Practice Address - Street 1:10 OROTE POINT RD
Practice Address - Street 2:
Practice Address - City:SANTA RITA
Practice Address - State:GU
Practice Address - Zip Code:96915-1130
Practice Address - Country:US
Practice Address - Phone:671-564-9098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman