Provider Demographics
NPI:1306895727
Name:BOSWELL, BILL N (MD)
Entity type:Individual
Prefix:DR
First Name:BILL
Middle Name:N
Last Name:BOSWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 PRINCETON RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2060
Mailing Address - Country:US
Mailing Address - Phone:423-928-0168
Mailing Address - Fax:423-928-5141
Practice Address - Street 1:508 PRINCETON RD
Practice Address - Street 2:SUITE 104
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2060
Practice Address - Country:US
Practice Address - Phone:423-928-0168
Practice Address - Fax:423-928-5141
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000015354208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3060284Medicaid
TNTN0103OtherJOHN DEERE
TN340012652OtherRAILROAD MEDICARE
TN0134347OtherBCBS
TN340012652OtherRAILROAD MEDICARE
TN0134347OtherBCBS