Healthcare Provider Details

I. General information

NPI: 1447683487
Provider Name (Legal Business Name): BRIAN T BAMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BRIAN T BOEHMER M.D.

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 BROADWAY ST
QUINCY IL
62301-2719
US

IV. Provider business mailing address

1005 BROADWAY ST
QUINCY IL
62301-2834
US

V. Phone/Fax

Practice location:
  • Phone: 217-224-6423
  • Fax: 217-223-9370
Mailing address:
  • Phone: 217-223-8400
  • Fax: 217-277-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2018016506
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036140217
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: