Provider Demographics
NPI:1457391088
Name:BOGGS, JEFFREY W (DPM)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:W
Last Name:BOGGS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 COLBY AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4324
Mailing Address - Country:US
Mailing Address - Phone:425-259-0855
Mailing Address - Fax:
Practice Address - Street 1:3202 COLBY AVE
Practice Address - Street 2:SUITE E
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4324
Practice Address - Country:US
Practice Address - Phone:425-259-0855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000514213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1086362Medicaid
WAPO00000514OtherSTATE LICENSE NUMBER
WAP00065056OtherRAILROAD MEDICARE
WA0114987OtherLABOR AND INDUSTRY
WAP00065056OtherRAILROAD MEDICARE
WAPO00000514OtherSTATE LICENSE NUMBER