MEDICARE: RICHARD J BOEHME 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	2084N0400X	Neurology Physician	ME62533	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00240372	OTHER	FL	RAILROAD MEDICARE
5	P00647889	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	212248	OTHER	FL	AVMED
4	18695	OTHER	FL	FLORIDA BCBS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245227800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD J BOEHME MD

Provider Business Mailing Address
First Line	:	PO BOX 17809
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32245-7809
Country	:	US
Telephone Number	:	904-249-4456
Fax Number	:	904-249-7703

Provider Business Practice Location Address
First Line	:	1361 13TH AVE S
Second Line	:	STE-170A
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3233
Country	:	US
Telephone Number	:	904-249-4456
Fax Number	:	904-249-7703

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

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	12/29/2011

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Directions to “ RICHARD J BOEHME MD” Practice Location

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