Basic Information
| Provider Information | |||||||||
| NPI: | 1295768828 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOEGER | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5299 | ||||||||
| Address2: | MS: 315-J1-TRM | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984150299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534037537 | ||||||||
| FaxNumber: | 2534037539 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 MARTIN LUTHER KING JR WAY | ||||||||
| Address2: | MS: 315-J1-TRM | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534037537 | ||||||||
| FaxNumber: | 2534037539 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 363AS0400X | PA10004154 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 8160BO | 01 | WA | REGENCE PIN | OTHER | 8362196 | 05 | WA | MEDICAID | 8930049 | 01 | WA | CRIME VICTIMS COMP PIN | OTHER | 179344 | 01 | WA | DEPT OF L&I PIN | OTHER | B003 | 01 | WA | TRICARE PIN | OTHER |