Individual
SAMUEL THOMAS BOSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11123 PARKVIEW PLAZA DR STE 200, FORT WAYNE, IN 46845-1707
(260) 425-6100
(260) 425-6105
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
01088906A
IN
2080P0206X
Pediatric Gastroenterology Physician
29983
OK
2080P0206X
Pediatric Gastroenterology Physician
E-12203
AR
Other
Enumeration date
04/29/2013
Last updated
03/23/2023
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