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General NPI Number Information
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NPI Number | 1912573775
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Entity Type | Individual
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Provider Name | WILLIAM JAMES BOEHM PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/02/2021
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 4909 SOUTHWESTERN BLVD
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City | HAMBURG
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State | NY
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Zip | 14075-2616
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Country | US
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Telephone | 716-926-6358
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Fax |
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Provider Business Mailing Address
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Address Line | 4566 BUCKINGHAM LN
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City | HAMBURG
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State | NY
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Zip | 14075-1918
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Country | US
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Telephone | 716-997-8262
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 025504
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License Number State | NY
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