MEDICARE: DANIEL JAMES BOEDEKER MD

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
1	207T00000X	Neurological Surgery Physician	24729	OK

General Provider Information

NPI Number	:	1225086945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL JAMES BOEDEKER MD

Provider Business Mailing Address
First Line	:	6767 S YALE AVE
Second Line	:	SUITE A
City	:	TULSA
State	:	OK
Zip	:	74136-3302
Country	:	US
Telephone Number	:	918-492-7587
Fax Number	:

Provider Business Practice Location Address
First Line	:	6767 S YALE AVE
Second Line	:	SUITE A
City	:	TULSA
State	:	OK
Zip	:	74136-3302
Country	:	US
Telephone Number	:	918-492-7587
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	12/16/2009

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