Provider Demographics
NPI:1801139498
Name:BOSSERT, FREDERICK ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:ROBERT
Last Name:BOSSERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FREDERICK
Other - Middle Name:ROBERT
Other - Last Name:BOSSERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:902 MCCALLIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2724
Mailing Address - Country:US
Mailing Address - Phone:423-664-4460
Mailing Address - Fax:
Practice Address - Street 1:902 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2724
Practice Address - Country:US
Practice Address - Phone:423-664-4460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN55605207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology