Provider Demographics
NPI:1902947799
Name:BOSWELL, CRAIG BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:BRIAN
Last Name:BOSWELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:969 N MASON RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6338
Mailing Address - Country:US
Mailing Address - Phone:314-628-8200
Mailing Address - Fax:314-628-9504
Practice Address - Street 1:969 N MASON RD
Practice Address - Street 2:SUITE 170
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6338
Practice Address - Country:US
Practice Address - Phone:314-628-8200
Practice Address - Fax:314-628-9504
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO108610208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH63954Medicare UPIN