Provider Demographics
NPI:1831658764
Name:BOSLEY, TAYLOR MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MICHAEL
Last Name:BOSLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BELFAIR CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-3054
Mailing Address - Country:US
Mailing Address - Phone:727-455-8438
Mailing Address - Fax:
Practice Address - Street 1:1271 OLD US 1 HWY
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-6308
Practice Address - Country:US
Practice Address - Phone:910-638-5554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-01171207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine