Provider Demographics
NPI:1114127289
Name:BOSWELL, RODNEY JEROME (CST/CFA)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:JEROME
Last Name:BOSWELL
Suffix:
Gender:M
Credentials:CST/CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 TRIMBLE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76134-5309
Mailing Address - Country:US
Mailing Address - Phone:817-291-5724
Mailing Address - Fax:817-293-5848
Practice Address - Street 1:8040 TRIMBLE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76134-5309
Practice Address - Country:US
Practice Address - Phone:817-291-5724
Practice Address - Fax:817-293-5848
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82243246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist