Provider Demographics
NPI:1467555987
Name:BOSTWICK, DAVID G (MD MBA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:BOSTWICK
Suffix:
Gender:M
Credentials:MD MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6925 LAKE ELLENOR DR STE 2
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-4631
Mailing Address - Country:US
Mailing Address - Phone:407-888-9934
Mailing Address - Fax:407-856-0333
Practice Address - Street 1:6925 LAKE ELLENOR DR STE 2
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809
Practice Address - Country:US
Practice Address - Phone:407-888-9934
Practice Address - Fax:407-856-0333
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29968207ZP0101X
CODR41625207ZP0101X
MDD23914207ZP0101X
FLME86147207ZP0101X
GA050869207ZP0101X
MN1003207ZP0101X
VA0101059208207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5001699OtherGHI
E38983Medicare UPIN