MEDICARE: LAURIE K BOEHM PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA9103644	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013090018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE K BOEHM PA

Provider Business Mailing Address
First Line	:	2428 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4304
Country	:	US
Telephone Number	:	850-215-6008
Fax Number	:	850-215-6020

Provider Business Practice Location Address
First Line	:	2428 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4304
Country	:	US
Telephone Number	:	850-215-6008
Fax Number	:	850-215-6020

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	03/15/2023

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Directions to “ LAURIE K BOEHM PA” Practice Location

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