Provider Demographics
NPI:1891768537
Name:BOJRAB, GEORGE DAVID (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:DAVID
Last Name:BOJRAB
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 1:10228 DUPONT CIRCLE DR EAST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825
Mailing Address - Country:US
Mailing Address - Phone:260-490-2525
Mailing Address - Fax:260-490-7254
Practice Address - Street 1:10228 DUPONT CIRCLE DR E
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1611
Practice Address - Country:US
Practice Address - Phone:260-490-2525
Practice Address - Fax:260-490-7254
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040336A208VP0014X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200037800AMedicaid
IN200037800AMedicaid
IN669450BMedicare ID - Type Unspecified