Provider Demographics
NPI:1508940107
Name:BOSEOVSKI, CHRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:
Last Name:BOSEOVSKI
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 1:5212 PIEDMONT DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-2846
Mailing Address - Country:US
Mailing Address - Phone:707-494-2802
Mailing Address - Fax:
Practice Address - Street 1:5212 PIEDMONT DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-2846
Practice Address - Country:US
Practice Address - Phone:707-494-2802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56189122300000X
VA0101276912208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018864420002Medicaid
PA215153OtherCIGNA
PA1589307OtherUNITED CONCORDIA
PA174855OtherCIGNA
PA874884OtherAETNA
PA1181283OtherGATEWAY
PA158984OtherUNISON
PA838906OtherAETNA