Provider Demographics
NPI:1649438912
Name:BOSLEY MEDICAL GROUP
Entity type:Organization
Organization Name:BOSLEY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-391-1963
Mailing Address - Street 1:5355 TOWN CENTER RD
Mailing Address - Street 2:STE 402
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1005
Mailing Address - Country:US
Mailing Address - Phone:561-391-1963
Mailing Address - Fax:561-445-9967
Practice Address - Street 1:5355 TOWN CENTER RD
Practice Address - Street 2:STE 402
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1005
Practice Address - Country:US
Practice Address - Phone:561-391-1963
Practice Address - Fax:561-445-9967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59524261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical