Individual
IRA KAEO BOSWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
5706 E MOCKINGBIRD LN STE 115-33, DALLAS, TX 75206-5460
(817) 284-9850
Mailing address
PO BOX 678135, DALLAS, TX 75267-8135
(469) 818-0595
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
Q3645
TX
Other
Enumeration date
06/02/2011
Last updated
01/26/2022
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