Provider Demographics
NPI:1952717571
Name:BOSLEY, ZACHARY O (DO)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:O
Last Name:BOSLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631
Mailing Address - Country:US
Mailing Address - Phone:304-675-4498
Mailing Address - Fax:304-675-2103
Practice Address - Street 1:2605 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-1615
Practice Address - Country:US
Practice Address - Phone:855-446-5937
Practice Address - Fax:304-675-2103
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV3219207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0237984Medicaid
WV1952717571Medicaid