Provider Demographics
NPI:1568633568
Name:DAVID BOGUE MD PLASTIC SURGERY PL
Entity Type:Organization
Organization Name:DAVID BOGUE MD PLASTIC SURGERY PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PARKER
Authorized Official - Last Name:BOGUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-886-1000
Mailing Address - Street 1:660 GLADES RD
Mailing Address - Street 2:SUITE 380
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6465
Mailing Address - Country:US
Mailing Address - Phone:561-886-1000
Mailing Address - Fax:561-393-2445
Practice Address - Street 1:660 GLADES RD
Practice Address - Street 2:SUITE 380
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6465
Practice Address - Country:US
Practice Address - Phone:561-886-1000
Practice Address - Fax:561-393-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100042208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty