Healthcare Provider Details

I. General information

NPI: 1598785362
Provider Name (Legal Business Name): JEFFREY A BOESTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 CLEARVISTA DRIVE SUITE 3500
INDIANAPOLIS IN
46256-1738
US

IV. Provider business mailing address

7120 CLEARVISTA DRIVE SUITE 3500
INDIANAPOLIS IN
46256-1738
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-2312
  • Fax: 317-621-2311
Mailing address:
  • Phone: 317-621-2312
  • Fax: 317-621-2311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number01024433A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: