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General NPI Number Information
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NPI Number | 1215934740
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Entity Type | Individual
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Provider Name | PETER JAMES BOSTICK MD
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Gender | Male
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 06/02/2020
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Provider Practice Location Address
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Address Line | 3401 NORTH BLVD STE 330
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City | BATON ROUGE
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State | LA
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Zip | 70806
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Country | US
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Telephone | 225-767-5520
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 14782
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City | BATON ROUGE
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State | LA
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Zip | 70898-4782
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Country | US
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Telephone | 225-767-5520
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Fax | 225-767-4934
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 12995R
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License Number State | LA
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