Provider Demographics
NPI:1447629233
Name:BOSWORTH, BRIAN PATRICK (PA-C)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PATRICK
Last Name:BOSWORTH
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:221 W COLORADO BLVD
Mailing Address - Street 2:PAV II SUITE 431
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-2363
Mailing Address - Country:US
Mailing Address - Phone:214-947-3684
Mailing Address - Fax:214-947-3239
Practice Address - Street 1:221 W COLORADO BLVD
Practice Address - Street 2:PAV II SUITE 431
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2363
Practice Address - Country:US
Practice Address - Phone:214-947-3684
Practice Address - Fax:214-947-3239
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2016-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL9109049363AS0400X
TXPA10521363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9109049OtherMEDICAL LICENSE NUMBER