Healthcare Provider Details

I. General information

NPI: 1538158001
Provider Name (Legal Business Name): JAMES R BOOGAERTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 FIELDSTOWN RD STE 124
GARDENDALE AL
35071-2418
US

IV. Provider business mailing address

PO BOX 55310
BIRMINGHAM AL
35255-5310
US

V. Phone/Fax

Practice location:
  • Phone: 205-631-3452
  • Fax:
Mailing address:
  • Phone: 205-731-9701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number12075
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: