MEDICARE: JAMES R BOOGAERTS 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	207RC0000X	Cardiovascular Disease Physician	12075	AL

General Provider Information

NPI Number	:	1538158001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES R BOOGAERTS MD

Provider Business Mailing Address
First Line	:	PO BOX 55310
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35255-5310
Country	:	US
Telephone Number	:	205-731-9701
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 FIELDSTOWN RD STE 124
Second Line	:
City	:	GARDENDALE
State	:	AL
Zip	:	35071-2418
Country	:	US
Telephone Number	:	205-631-3452
Fax Number	:

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	07/21/2022

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