MEDICARE: DR. DONALD JEFFREY BOSS M.D.

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	2085R0202X	Diagnostic Radiology Physician	G383220	CA

General Provider Information

NPI Number	:	1629075247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD JEFFREY BOSS M.D.

Provider Business Mailing Address
First Line	:	27520 HAWTHORNE BLVD. #220
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-3580
Country	:	US
Telephone Number	:	310-706-4440
Fax Number	:	310-706-4441

Provider Business Practice Location Address
First Line	:	27520 HAWTHORNE BLVD. #220
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-3580
Country	:	US
Telephone Number	:	310-706-4440
Fax Number	:	310-706-4441

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

Provider Enumeration Date	:	06/29/2005
Last Update Date	:	05/01/2013

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