Basic Information
| Provider Information | |||||||||
| NPI: | 1023022456 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOESCH | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7542 E ORION CIR | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852070924 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1010 N COUNTRY CLUB DR | ||||||||
| Address2: | BANNER MESA MEDICAL CENTER | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852013309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808341211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 20380 | AZ | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.