Provider Demographics
NPI:1275871972
Name:J. SCOTT BOSWELL, MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:J. SCOTT BOSWELL, MD A MEDICAL CORPORATION
Other - Org Name:BOSWELL DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BOSWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-439-3000
Mailing Address - Street 1:6730 N WEST AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-4301
Mailing Address - Country:US
Mailing Address - Phone:559-439-3000
Mailing Address - Fax:559-439-3004
Practice Address - Street 1:6730 N WEST AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-4301
Practice Address - Country:US
Practice Address - Phone:559-439-3000
Practice Address - Fax:559-439-3004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty