Provider Demographics
NPI:1669008280
Name:BOSLEY, ANTHONY D SR
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:D
Last Name:BOSLEY
Suffix:SR
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 1:2721 N WHIPPLE CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4708
Mailing Address - Country:US
Mailing Address - Phone:509-608-2380
Mailing Address - Fax:509-267-0071
Practice Address - Street 1:2721 N WHIPPLE CT
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4708
Practice Address - Country:US
Practice Address - Phone:509-608-2380
Practice Address - Fax:509-267-0071
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-15
Last Update Date:2020-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7638156OtherPROVIDER