Provider Demographics
NPI:1427491117
Name:RONALD J BOISEN MD PC
Entity type:Organization
Organization Name:RONALD J BOISEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BIOSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-569-1333
Mailing Address - Street 1:3851 PIPER ST
Mailing Address - Street 2:SUITE U466
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4684
Mailing Address - Country:US
Mailing Address - Phone:907-569-1333
Mailing Address - Fax:907-569-1433
Practice Address - Street 1:3851 PIPER ST
Practice Address - Street 2:SUITE U466
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4684
Practice Address - Country:US
Practice Address - Phone:907-569-1333
Practice Address - Fax:907-569-1433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK2221207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD9895Medicaid
AKK151712OtherMEDICARE PTAN
AKC97005Medicare UPIN