Healthcare Provider Details

I. General information

NPI: 1275871972
Provider Name (Legal Business Name): J. SCOTT BOSWELL, MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6730 N WEST AVE
FRESNO CA
93711-4301
US

IV. Provider business mailing address

6730 N WEST AVE
FRESNO CA
93711-4301
US

V. Phone/Fax

Practice location:
  • Phone: 559-439-3000
  • Fax: 559-439-3004
Mailing address:
  • Phone: 559-439-3000
  • Fax: 559-439-3004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN SCOTT BOSWELL
Title or Position: PHYSICIAN
Credential: MD
Phone: 559-439-3000