MEDICARE: JOHN SCOTT BOSWELL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	A100542	CA
2	207NS0135X	Procedural Dermatology Physician	A100542	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0A1005420	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1295936961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN SCOTT BOSWELL MD

Provider Business Mailing Address
First Line	:	6730 N WEST AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-4301
Country	:	US
Telephone Number	:	559-439-3000
Fax Number	:	559-439-3004

Provider Business Practice Location Address
First Line	:	6730 N WEST AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-4301
Country	:	US
Telephone Number	:	559-439-3000
Fax Number	:	559-439-3004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	08/02/2023

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Directions to “ JOHN SCOTT BOSWELL MD” Practice Location

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