Healthcare Provider Details

I. General information

NPI: 1417953332
Provider Name (Legal Business Name): THOMAS J BOES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 OLENTANGY RIVER RD STE 201
COLUMBUS OH
43214-3907
US

IV. Provider business mailing address

3545 OLENTANGY RIVER RD STE 201
COLUMBUS OH
43214-3907
US

V. Phone/Fax

Practice location:
  • Phone: 614-267-8585
  • Fax: 614-267-9793
Mailing address:
  • Phone: 614-267-8585
  • Fax: 614-267-9793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: