| Doctor Name: | ANDREW MILLER IBRAHIM BOGLE |
| NPI Number: | 1669598587 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | |
| Business Practice Address: | 13700 St Francis Blvd Suite 103 Midlothian, VA - 231143222 |
| Business Phone Number: | 8043792414 |
| Business Fax Number: | 8043792413 |
| Mailing Address: | 1115 Boulders Pkwy, Suite 200 NORTH CHESTERFIELD |
| State: | VA |
| Postal Code: | 232254067 |
| Phone Number: | 8045605595 |
| Fax Number: | 8045609029 |
| NPI Enumeration Date: | 03/22/2007 |
| NPI Last Update Date: | 11/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |