Provider Demographics
NPI:1821121963
Name:BOSWELL, JEFFREY MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MITCHELL
Last Name:BOSWELL
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 1:229 CORNELIA LN
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-8448
Mailing Address - Country:US
Mailing Address - Phone:979-848-7006
Mailing Address - Fax:
Practice Address - Street 1:2401 5TH AVE S
Practice Address - Street 2:BP TEXAS CITY BUSINESS UNIT MEDICAL DEPARTMENT
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77592-0401
Practice Address - Country:US
Practice Address - Phone:409-945-1162
Practice Address - Fax:409-942-4092
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG31702083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine