Provider Demographics
NPI:1407819766
Name:BOS, GARY D (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:D
Last Name:BOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:611 S CHESTNUT ST
Mailing Address - Street 2:STE. D
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-4815
Mailing Address - Country:US
Mailing Address - Phone:509-933-8700
Mailing Address - Fax:509-933-8705
Practice Address - Street 1:611 S CHESTNUT ST
Practice Address - Street 2:STE. D
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-4815
Practice Address - Country:US
Practice Address - Phone:509-573-3989
Practice Address - Fax:509-933-8705
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2012-11-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00046975207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAC92252Medicare UPIN