Provider Demographics
NPI:1144666785
Name:BOSLEY, MICAH RYAN (MD)
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:RYAN
Last Name:BOSLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 20771
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4104
Mailing Address - Country:US
Mailing Address - Phone:713-466-0197
Mailing Address - Fax:713-849-3424
Practice Address - Street 1:17347 VILLAGE GREEN DR
Practice Address - Street 2:
Practice Address - City:JERSEY VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:77040-1159
Practice Address - Country:US
Practice Address - Phone:713-466-0197
Practice Address - Fax:713-849-3424
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2025-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ1797207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine