Provider Demographics
NPI:1164518080
Name:BOSOMWORTH, DAVID P II (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:BOSOMWORTH
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7145 E VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-9144
Mailing Address - Country:US
Mailing Address - Phone:812-962-7890
Mailing Address - Fax:812-476-6162
Practice Address - Street 1:279 KINGS DAUGHTERS DR STE 100
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601
Practice Address - Country:US
Practice Address - Phone:502-353-2530
Practice Address - Fax:502-352-2534
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2022-04-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY30546208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000328632OtherBLUE CROSS AND BLUESHIELD
KY64305469Medicaid
F89743Medicare UPIN
KY64305469Medicaid