Provider Demographics
NPI:1629055686
Name:BOZICH, CHRISTINE M (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:BOZICH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1706 MERIDIAN S
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-7516
Mailing Address - Country:US
Mailing Address - Phone:253-848-8797
Mailing Address - Fax:253-446-3239
Practice Address - Street 1:1706 MERIDIAN S
Practice Address - Street 2:SUITE 120
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-7516
Practice Address - Country:US
Practice Address - Phone:253-848-8797
Practice Address - Fax:253-446-3239
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
WAMD00033472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8192536OtherDSHS NUMBER
WA181178OtherLABOR & INDUSTRY NUMBER