Healthcare Provider Details

I. General information

NPI: 1710155544
Provider Name (Legal Business Name): ARTHUR R BOERNER MD PMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 SPRING ST SUITE 2
JEFFERSONVILLE IN
47130-3748
US

IV. Provider business mailing address

PO BOX 770
JEFFERSONVILLE IN
47131-0770
US

V. Phone/Fax

Practice location:
  • Phone: 812-288-9646
  • Fax: 812-283-8391
Mailing address:
  • Phone: 812-288-9646
  • Fax: 812-283-8391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01061638A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71002263A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01029076A
License Number StateIN

VIII. Authorized Official

Name: ARTHUR R BOERNER
Title or Position: MD OWNER
Credential: MD
Phone: 812-288-9646