MEDICARE: BEAU J BOSTWICK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1346519972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEAU J BOSTWICK

Provider Business Mailing Address
First Line	:	USS DEFENDER
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96663-1922
Country	:	US
Telephone Number	:	08027382390
Fax Number	:

Provider Business Practice Location Address
First Line	:	USS DEFENDER
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96663-1922
Country	:	US
Telephone Number	:	08027382390
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2011
Last Update Date	:	12/28/2011

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Directions to “ BEAU J BOSTWICK ” Practice Location

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