Provider Demographics
NPI:1548267032
Name:BOSSARD, KERRIE ROCHELLE (MD)
Entity type:Individual
Prefix:
First Name:KERRIE
Middle Name:ROCHELLE
Last Name:BOSSARD
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 1:2751 DEBARR RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2952
Mailing Address - Country:US
Mailing Address - Phone:907-222-1401
Mailing Address - Fax:907-222-1402
Practice Address - Street 1:2751 DEBARR RD
Practice Address - Street 2:SUITE 280
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2952
Practice Address - Country:US
Practice Address - Phone:907-222-1401
Practice Address - Fax:907-222-1402
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35946208600000X
NE26798208C00000X
AK8070208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
APPLYING FORMedicare ID - Type Unspecified