Provider Demographics
NPI:1649446568
Name:DON R BOSSE MD PA
Entity type:Organization
Organization Name:DON R BOSSE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOSSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-865-3124
Mailing Address - Street 1:235 W PALM ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BELLVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77418-1372
Mailing Address - Country:US
Mailing Address - Phone:979-865-3124
Mailing Address - Fax:979-865-9193
Practice Address - Street 1:235 W PALM ST
Practice Address - Street 2:SUITE 105
Practice Address - City:BELLVILLE
Practice Address - State:TX
Practice Address - Zip Code:77418-1372
Practice Address - Country:US
Practice Address - Phone:979-865-3124
Practice Address - Fax:979-865-9193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3169207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128016602Medicaid
TXC13633Medicare UPIN
TX128016602Medicaid