Provider Demographics
NPI:1952339319
Name:BOGARD, JOHN FITZGERALD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FITZGERALD
Last Name:BOGARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4770 NE LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8942
Mailing Address - Country:US
Mailing Address - Phone:360-536-7869
Mailing Address - Fax:
Practice Address - Street 1:1 BOONE RD
Practice Address - Street 2:CODE 04OP
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-1894
Practice Address - Country:US
Practice Address - Phone:360-475-4295
Practice Address - Fax:360-475-4411
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38684207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology