Provider Demographics
NPI:1821743519
Name:BRENT W. BOST, MD, PA
Entity Type:Organization
Organization Name:BRENT W. BOST, MD, PA
Other - Org Name:SELF
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-880-5800
Mailing Address - Street 1:4012 SPRING HOLLOW ST
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-4604
Mailing Address - Country:US
Mailing Address - Phone:409-880-5800
Mailing Address - Fax:
Practice Address - Street 1:1650 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3565
Practice Address - Country:US
Practice Address - Phone:409-880-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-21
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty