Provider Demographics
NPI:1316033475
Name:BOCANEGRA, JOSE A JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:BOCANEGRA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 638269
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-8269
Mailing Address - Country:US
Mailing Address - Phone:440-816-2878
Mailing Address - Fax:
Practice Address - Street 1:10139 ROYALTON RD STE H
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-4473
Practice Address - Country:US
Practice Address - Phone:440-816-2878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0007456582OtherAETNA PROVDER ID#
OH2479442OtherUNITED HEALTHCARE
OH1003087OtherQUALCHOICE
OH000000350199OtherANTHEM BLUE CROSS BLUE SH
OH1003087OtherQUALCHOICE
OH1003087OtherQUALCHOICE