Provider Demographics
NPI:1619960119
Name:BOSLEY, JOSEPH HOUSTON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:HOUSTON
Last Name:BOSLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:HOUSTON
Other - Last Name:BOSLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2533 BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:#104
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3158
Mailing Address - Country:US
Mailing Address - Phone:318-688-8801
Mailing Address - Fax:318-688-8861
Practice Address - Street 1:2533 BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:#104
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3158
Practice Address - Country:US
Practice Address - Phone:318-688-8801
Practice Address - Fax:318-688-8861
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06657R207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1353523OtherLSU MEDICAID
LA1799611Medicaid
B62019Medicare UPIN
LA5M799Medicare PIN