Active NPI
Doyle Lon Bosse, M.D.
- Pediatrics Physician
- Marianna, FL
National Provider Identifier
1568623486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- ME57543
- Practice address
- 4230 Hospital Dr
Suite 102
Marianna, FL 32446-1934 - Phone
- (850) 482-2004
- Fax
- (850) 482-4778
- NPI assigned
- Jun 23, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | ME57543 | FL | Primary |
Addresses
Primary practice location
4230 Hospital Dr
Suite 102
Marianna, FL 32446-1934
Mailing address
4230 Hospital Dr
Suite 102
Marianna, FL 32446-1934
Phone (850) 482-2004
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 063340200 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME57543 | FL | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Marianna Pediatric Associates PA | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- doyleb@f6eaaff6.micromddirect.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214179200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214179200000",
"number": "1568623486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4230 HOSPITAL DR",
"address_2": "SUITE 102",
"city": "MARIANNA",
"state": "FL",
"postal_code": "324461934",
"telephone_number": "850-482-2004",
"fax_number": "850-482-4778"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4230 HOSPITAL DR",
"address_2": "SUITE 102",
"city": "MARIANNA",
"state": "FL",
"postal_code": "324461934",
"telephone_number": "850-482-2004",
"fax_number": "850-482-4778"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOSSE",
"first_name": "DOYLE",
"middle_name": "LON",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-06-23",
"last_updated": "2008-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "FL",
"license": "ME57543",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "063340200",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marianna, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.