Healthcare Provider Details

I. General information

NPI: 1043452378
Provider Name (Legal Business Name): BRIAN ALAN BOE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N 35TH AVE STE 490
HOLLYWOOD FL
33021-5423
US

IV. Provider business mailing address

2900 CORPORATE WAY DOOR D
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-3437
  • Fax: 954-983-5052
Mailing address:
  • Phone: 954-276-5685
  • Fax: 954-276-0357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME156552
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License NumberME156552
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberME156552
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: