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General NPI Number Information
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NPI Number | 1972708162
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Entity Type | Organization
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Legal Business Name | MARY ROSE BOEHM MD PA
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 200 E HIGHLAND AVE
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City | CLERMONT
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State | FL
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Zip | 34711-2582
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Country | US
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Telephone | 352-242-1430
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Fax | 352-242-1452
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Provider Business Mailing Address
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Address Line | 614 E HIGHWAY 50
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City | CLERMONT
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State | FL
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Zip | 34711-3164
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Country | US
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Telephone | 352-242-1430
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Fax | 352-242-1452
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MARY ROSE BOEHM
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Credential | MD
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Telephone | 352-242-1430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME88288
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License Number State | FL
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