Provider Demographics
NPI:1316093222
Name:BOGGIE, MARK P, (MED)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:P,
Last Name:BOGGIE
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5256 S SANTA CLAUS AVE
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85650-8998
Mailing Address - Country:US
Mailing Address - Phone:520-515-2800
Mailing Address - Fax:520-515-2877
Practice Address - Street 1:5225 E BUENA SCHOOL BLVD
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2392
Practice Address - Country:US
Practice Address - Phone:520-515-2800
Practice Address - Fax:520-515-2877
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool