Provider Demographics
NPI:1922073196
Name:BOSLEY, JEFFREY S (MPAS)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:S
Last Name:BOSLEY
Suffix:
Gender:M
Credentials:MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4512 N 40TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3604
Mailing Address - Country:US
Mailing Address - Phone:602-954-7546
Mailing Address - Fax:602-952-2941
Practice Address - Street 1:4512 N 40TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3604
Practice Address - Country:US
Practice Address - Phone:602-954-7546
Practice Address - Fax:602-952-2941
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02321363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical