Basic Information
| Provider Information | |||||||||
| NPI: | 1578628657 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOSWELL | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 780 KUENZLI ST | ||||||||
| Address2: | STE 202 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895020837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7759824590 | ||||||||
| FaxNumber: | 7759824595 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 LIMITED LN NW | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985022704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603579392 | ||||||||
| FaxNumber: | 3603579485 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 01/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | OP60354605 | WA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | OP60354605 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 2083X0100X | OP60354605 | WA | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | 207QA0505X | OP60354605 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
ID Information
| ID | Type | State | Issuer | Description | 11039788 | 01 | CAQH | OTHER |