Provider Demographics
NPI:1053303321
Name:BOSCH, BARBARA L (MD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:L
Last Name:BOSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 W FOREST AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1479
Mailing Address - Country:US
Mailing Address - Phone:928-214-3600
Mailing Address - Fax:928-214-3601
Practice Address - Street 1:77 W FOREST AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1479
Practice Address - Country:US
Practice Address - Phone:928-214-3600
Practice Address - Fax:928-214-3601
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32739208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ856495Medicaid
AZ0753850OtherBCBS
AZ5217269OtherCIGNA
AZ2Z1003OtherHEALTH NET
AZ5592602OtherAETNA