Bose, Brent Jerrod
Bose, Brent Jerrod is an individual health care provider with primary practice located at 842 E Main St , Medford OR 97504-7134. He recently has only one registered license in Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology, which is considered as his primary health care specialty. Bose, Brent Jerrod can be contacted via phone (541) 618-5800.Contact Information
Primary practice address
842 E Main St
Medford OR 97504-7134
Phone: (541) 618-5800
Fax: (541) 779-3027
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology | 2085R0204X | 15785 | New Hampshire |
| Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology | 2085R0204X | MD161662 | Oregon |
Profile Details
| NPI number | 1841435047 |
|---|---|
| LBN Legal business name | Bose, Brent Jerrod |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 3rd, 2008 |
| Last updated | Jan 31st, 2023 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1841435047 | NPPES |
| Oregon | MEDICAID | 500657645 | |
| Oregon | Other | R170676 |
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