Provider Demographics
NPI:1134655756
Name:BOSEN, BENJAMIN CHARLES (DO)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:CHARLES
Last Name:BOSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCIS
Mailing Address - State:KS
Mailing Address - Zip Code:67756-3540
Mailing Address - Country:US
Mailing Address - Phone:785-332-2682
Mailing Address - Fax:
Practice Address - Street 1:288 S PARADISE PKWY # 154
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:UT
Practice Address - Zip Code:84028-7909
Practice Address - Country:US
Practice Address - Phone:435-255-1630
Practice Address - Fax:435-946-9124
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11805306-1204207Q00000X
KS05-44029207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine