Healthcare Provider Details

I. General information

NPI: 1508705567
Provider Name (Legal Business Name): WILLIAM BOERGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 SCOUT CIR
HERNANDO MS
38632-1921
US

IV. Provider business mailing address

691 SCOUT CIR
HERNANDO MS
38632-1921
US

V. Phone/Fax

Practice location:
  • Phone: 386-624-3613
  • Fax:
Mailing address:
  • Phone: 386-624-3613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License Number070307-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: