Healthcare Provider Details

I. General information

NPI: 1033856471
Provider Name (Legal Business Name): DUNCAN SCOTT BOSWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 SAINT LUKES DR
MONTGOMERY AL
36117-7104
US

IV. Provider business mailing address

488 SAINT LUKES DR
MONTGOMERY AL
36117-7104
US

V. Phone/Fax

Practice location:
  • Phone: 334-288-7808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-132357
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: