Provider Demographics
NPI:1295768828
Name:BOEGER, CHRISTOPHER R (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:R
Last Name:BOEGER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 YAKIMA AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5303
Mailing Address - Country:US
Mailing Address - Phone:253-426-6272
Mailing Address - Fax:253-426-4060
Practice Address - Street 1:1802 YAKIMA AVE STE 104
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5303
Practice Address - Country:US
Practice Address - Phone:253-426-6272
Practice Address - Fax:253-426-4060
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004154363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1035405Medicaid
WAB003OtherTRICARE PIN
WA8160BOOtherREGENCE PIN
WA179344OtherDEPT OF L&I PIN
WA8930049OtherCRIME VICTIMS COMP PIN
WA8362196Medicaid
WA179344OtherDEPT OF L&I PIN