Provider Demographics
NPI:1942232962
Name:BOGGS, LEO R JR (MD)
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:R
Last Name:BOGGS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LEO
Other - Middle Name:R
Other - Last Name:BOGGS
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:700 ACKERMAN RD SUITE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202
Mailing Address - Country:US
Mailing Address - Phone:614-293-8000
Mailing Address - Fax:
Practice Address - Street 1:410 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-9696
Practice Address - Country:US
Practice Address - Phone:614-293-8000
Practice Address - Fax:614-293-3124
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38244207P00000X
OH35.058028207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0776889Medicaid
KY64957210Medicaid
0741051Medicare ID - Type Unspecified