Healthcare Provider Details

I. General information

NPI: 1922133321
Provider Name (Legal Business Name): DONALD KENNETH BOEHM JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 MEDICAL CENTER DR EAST #101
CLOVIS CA
93611
US

IV. Provider business mailing address

722 MEDICAL CENTER DR EAST #101
CLOVIS CA
93611
US

V. Phone/Fax

Practice location:
  • Phone: 559-297-9500
  • Fax: 559-297-9572
Mailing address:
  • Phone: 559-297-9500
  • Fax: 559-297-9572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC34015
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: