Provider Demographics
NPI:1740356088
Name:BOGUS, DEVIN L (MD)
Entity type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:L
Last Name:BOGUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9201 MONTGOMERY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2468
Mailing Address - Country:US
Mailing Address - Phone:505-298-2505
Mailing Address - Fax:505-298-2985
Practice Address - Street 1:9201 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2468
Practice Address - Country:US
Practice Address - Phone:505-298-2505
Practice Address - Fax:505-298-2985
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2013-0041208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM92750737Medicaid
TNI49712Medicare UPIN
TN103I379698Medicare PIN