Individual
JOHN CECIL BOSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
7362 W PARKS HWY STE 228, WASILLA, AK 99623-9300
(907) 355-4083
(907) 376-2811
Mailing address
7362 W PARKS HWY # 801, WASILLA, AK 99623-9300
(907) 355-4084
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5285
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201322021
TAX ID
AK
01
—
610518000
DEPARTMENT OF LABOR
AK
01
—
DC8103
MEDICARE RAILROAD
AK
05
—
MD2914
—
AK
Enumeration date
04/04/2006
Last updated
10/02/2024
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