Michael Wilfred Prosper Boos Jr., MD
Individual provider Active NPI Obstetrics & Gynecology Physician · Lafayette, LA
NPI 1932109451 · NPPES record last updated Sep 24, 2013
Key facts
- NPI
- 1932109451
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 13759 (LA)
- Practice address
- 4640 Ambassador Caffery Pkwy
Lafayette, LA 70508-6902 - Phone
- (337) 984-1050
- Fax
- (337) 984-8776
- NPI assigned
- Jul 27, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13759 | LA | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Apex Prevention, LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 13759 | LA | Yes |
Addresses
Primary practice location
4640 Ambassador Caffery Pkwy
Lafayette, LA 70508-6902
Mailing address
4640 Ambassador Caffery Pkwy
Lafayette, LA 70508-6902
Phone (337) 984-1050
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1309257 | Medicaid | LA |
Other providers in Lafayette, LA
- Swanzette Bonnet
- Suzette Bonneval
- Latasha Ann Bonnie
- Chris David Bonvillain
- David T Booher
- Patrick Booth
- Traci Lynn Boothe
- Kristina Bordeaux
- Amy Brooke Bordelon
- Haley Nicole Bordelon
All providers in Lafayette, LA · Obstetrics & Gynecology Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 24, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.