Healthcare Provider Details

I. General information

NPI: 1407840895
Provider Name (Legal Business Name): JEFFREY A BOSWORTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 PLACER ST
REDDING CA
96001-1125
US

IV. Provider business mailing address

1035 PLACER ST
REDDING CA
96001-1125
US

V. Phone/Fax

Practice location:
  • Phone: 530-246-5710
  • Fax: 530-244-7846
Mailing address:
  • Phone: 530-246-5710
  • Fax: 530-244-7846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG077006
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: