Provider Demographics
NPI:1437181989
Name:BOFFMAN, HARRY R JR
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:R
Last Name:BOFFMAN
Suffix:JR
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 1:655 EUCLID AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2957
Mailing Address - Country:US
Mailing Address - Phone:619-267-3020
Mailing Address - Fax:619-267-4042
Practice Address - Street 1:655 EUCLID AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2957
Practice Address - Country:US
Practice Address - Phone:619-267-3020
Practice Address - Fax:619-267-4042
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG258220207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G258220Medicaid
CAA89426Medicare UPIN
CA1011700001Medicare NSC