Provider Demographics
NPI:1063426989
Name:BOGEY, ROSS (DO)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:BOGEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2185
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99210-2185
Mailing Address - Country:US
Mailing Address - Phone:509-473-6869
Mailing Address - Fax:509-474-6606
Practice Address - Street 1:715 S COWLEY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202
Practice Address - Country:US
Practice Address - Phone:509-473-6706
Practice Address - Fax:509-473-6704
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6488208100000X
WAOP60924421208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109440-1Medicaid
IL036109440-2Medicaid
ILP00101984OtherRAILROAD MEDICARE
ILK07658Medicare PIN
ILK01622Medicare PIN
IL036109440-1Medicaid
ILP00101984OtherRAILROAD MEDICARE