Provider Demographics
NPI:1881411007
Name:BOGGS JR, RAYMOND
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:BOGGS JR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 GERTRUDE AVE
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-2905
Mailing Address - Country:US
Mailing Address - Phone:330-330-5777
Mailing Address - Fax:
Practice Address - Street 1:33 GERTRUDE AVE
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-2905
Practice Address - Country:US
Practice Address - Phone:330-330-5777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide