Provider Demographics
NPI:1093807760
Name:BOSWELL, LINDA P (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:P
Last Name:BOSWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 5258
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71171-5258
Mailing Address - Country:US
Mailing Address - Phone:318-949-0882
Mailing Address - Fax:318-949-0882
Practice Address - Street 1:1006 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4103
Practice Address - Country:US
Practice Address - Phone:318-949-0882
Practice Address - Fax:318-949-0882
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA0140922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1310310Medicaid
LAB88944Medicare UPIN