Provider Demographics
NPI:1558476507
Name:BOSSE, DAVID AARON (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:AARON
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 1:1500 ANDOVER CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8380
Mailing Address - Country:US
Mailing Address - Phone:979-690-8736
Mailing Address - Fax:
Practice Address - Street 1:1500 ANDOVER CT
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8380
Practice Address - Country:US
Practice Address - Phone:979-690-8736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG44462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPOR6390Medicaid
TX81R639Medicare ID - Type Unspecified
TXPOR6390Medicaid