Individual
BRUCE B BOSWELL
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1800 BARRS ST, JACKSONVILLE, FL 32204-4704
(904) 387-4030
(904) 381-9808
Mailing address
2165 HERSCHEL ST, JACKSONVILLE, FL 32204-3819
(904) 387-4030
(904) 381-9808
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
055143
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00926802A
MEDICAID
GA
01
—
56737
BCBS
FL
Enumeration date
09/12/2005
Last updated
07/08/2007
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