Provider Demographics
NPI:1184617524
Name:BOGARD, DENISE RUTH (MD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:RUTH
Last Name:BOGARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 GIBSON DR STE 290
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-5795
Mailing Address - Country:US
Mailing Address - Phone:916-781-4300
Mailing Address - Fax:916-781-4301
Practice Address - Street 1:508 GIBSON DR STE 290
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-5795
Practice Address - Country:US
Practice Address - Phone:916-481-6800
Practice Address - Fax:916-481-1881
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69673207L00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0028370Medicaid
CAZZZ16448ZMedicare ID - Type Unspecified
CAGR0028370Medicaid