Provider Demographics
NPI:1831336155
Name:BOOSE, WESLEY DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:DAVID
Last Name:BOOSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1663
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-0600
Mailing Address - Country:US
Mailing Address - Phone:505-667-0660
Mailing Address - Fax:505-665-9639
Practice Address - Street 1:LANL TA- 03 BUILDING 1411 RM 156 PAJARITO ST
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87545-3750
Practice Address - Country:US
Practice Address - Phone:505-667-3511
Practice Address - Fax:505-665-9639
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2023-12122083X0100X
SC859642083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty