Healthcare Provider Details

I. General information

NPI: 1821311358
Provider Name (Legal Business Name): JASON TYLER BOEHME M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE, M-691 UCSF # 0110
SAN FRANCISCO CA
94143
US

IV. Provider business mailing address

505 PARNASSUS AVE, M-691 UCSF BOX 0110
SAN FRANCISCO CA
94143
US

V. Phone/Fax

Practice location:
  • Phone: 415-443-2905
  • Fax:
Mailing address:
  • Phone: 415-443-2905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA111249
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: