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NPI Code Detail

MEDICARE: DR. CLIFFORD KENT BOESE M.D.

MEDICARE: DR. CLIFFORD KENT BOESE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207X00000XOrthopaedic Surgery Physician19711NE
2207X00000XOrthopaedic Surgery Physician30053IA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2200017652OTHERIAMEDICARE TRAVELERS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
116464OTHERIAWELLMARK
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225036916
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CLIFFORD KENT BOESE M.D.
Provider Business Mailing Address
First Line : 1 EDMUNDSON PL
Second Line : STE 500
City : COUNCIL BLUFFS
State : IA
Zip : 51503-4619
Country : US
Telephone Number : 712-323-5333
Fax Number : 712-323-3252
Provider Business Practice Location Address
First Line : 1 EDMUNDSON PL
Second Line : STE 500
City : COUNCIL BLUFFS
State : IA
Zip : 51503-4619
Country : US
Telephone Number : 712-323-5333
Fax Number : 712-323-3252
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 07/12/2012

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Directions to “ DR. CLIFFORD KENT BOESE M.D.” Practice Location

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