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Individual

CRAIG LEE BOSWELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1001 E PRIMROSE ST, SPRINGFIELD, MO 65807-7006
(417) 875-3462
Mailing address
PO BOX 9007, SPRINGFIELD, MO 65808-9007
(417) 875-3462

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
2001010847
MO
2085R0204X
Vascular & Interventional Radiology Physician
Primary
2001010847
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1256
BLUE
MO
05
143642001
AR
05
205298110
MO
05
205298128
MO
01
P00191393
RRR MEDICARE
MO
Enumeration date
03/21/2006
Last updated
12/27/2018
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