Provider Demographics
NPI:1386655520
Name:BOGGS, BRANDON EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:EDWARD
Last Name:BOGGS
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 1:3178 COLLINS DR
Mailing Address - Street 2:STE B
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-3155
Mailing Address - Country:US
Mailing Address - Phone:209-233-9038
Mailing Address - Fax:209-580-4741
Practice Address - Street 1:3178 COLLINS DR
Practice Address - Street 2:STE B
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3155
Practice Address - Country:US
Practice Address - Phone:209-233-9038
Practice Address - Fax:209-580-4741
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77822146D00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A778220Medicaid
CA00A778227Medicare PIN
CAH58011Medicare UPIN
CA00A778223Medicare PIN
CA00A778220Medicaid
00A778225Medicare PIN