Provider Demographics
NPI:1326016791
Name:BOSSE, DON R (MD)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:R
Last Name:BOSSE
Suffix:
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 1:235 W PALM ST STE 105
Mailing Address - Street 2:
Mailing Address - City:BELLVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77418-1300
Mailing Address - Country:US
Mailing Address - Phone:979-865-3124
Mailing Address - Fax:979-865-9193
Practice Address - Street 1:235 W PALM
Practice Address - Street 2:SUITE 105
Practice Address - City:BELLVILLE
Practice Address - State:TX
Practice Address - Zip Code:77418-1372
Practice Address - Country:US
Practice Address - Phone:979-865-3124
Practice Address - Fax:979-865-9193
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3169207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110207986OtherMEDICARE RAILROAD
TX128016607Medicaid
110207986OtherMEDICARE RAILROAD
TX128016607Medicaid
TX85610FMedicare PIN
TX85610FMedicare PIN