MEDICARE: JOHN CECIL BOSTON D.O.

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	207R00000X	Internal Medicine Physician	5285	AK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC8103	OTHER	AK	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	610518000	OTHER	AK	DEPARTMENT OF LABOR
4	201322021	OTHER	AK	TAX ID

General Provider Information

NPI Number	:	1982666137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN CECIL BOSTON D.O.

Provider Business Mailing Address
First Line	:	7362 W PARKS HWY # 801
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99623-9300
Country	:	US
Telephone Number	:	907-355-4084
Fax Number	:

Provider Business Practice Location Address
First Line	:	7362 W PARKS HWY STE 228
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99623-9300
Country	:	US
Telephone Number	:	907-355-4083
Fax Number	:	907-376-2811

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

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	10/02/2024

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Directions to “ JOHN CECIL BOSTON D.O.” Practice Location

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