Healthcare Provider Details

I. General information

NPI: 1427068436
Provider Name (Legal Business Name): LARRY R BOEHME MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1899 N MARINE BLVD
JACKSONVILLE NC
28546-6555
US

IV. Provider business mailing address

1899 N MARINE BLVD
JACKSONVILLE NC
28546-6555
US

V. Phone/Fax

Practice location:
  • Phone: 910-347-1515
  • Fax: 910-347-7982
Mailing address:
  • Phone: 910-347-1515
  • Fax: 910-347-7982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: