Provider Demographics
NPI:1295027910
Name:BOSLEY, RAWN EDWARD (MD)
Entity Type:Individual
Prefix:MR
First Name:RAWN
Middle Name:EDWARD
Last Name:BOSLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 E SOUTHLAKE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1476
Mailing Address - Country:US
Mailing Address - Phone:817-329-1350
Mailing Address - Fax:817-329-1366
Practice Address - Street 1:925 E SOUTHLAKE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-1476
Practice Address - Country:US
Practice Address - Phone:817-329-1350
Practice Address - Fax:817-329-1366
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR1001207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology