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General NPI Number Information
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NPI Number | 1831336155
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Entity Type | Individual
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Provider Name | WESLEY DAVID BOOSE M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/08/2009
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | LANL TA- 03 BUILDING 1411 RM 156 PAJARITO ST
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City | LOS ALAMOS
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State | NM
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Zip | 87545-3750
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Country | US
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Telephone | 505-667-3511
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Fax | 505-665-9639
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Provider Business Mailing Address
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Address Line | PO BOX 1663
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City | LOS ALAMOS
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State | NM
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Zip | 87544-0600
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Country | US
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Telephone | 505-667-0660
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Fax | 505-665-9639
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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 | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | MD2023-1212
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License Number State | NM
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