MEDICARE: MATTHEW J BOECKMAN MD

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	29617	OK
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	MD446546	PA

General Provider Information

NPI Number	:	1861641961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW J BOECKMAN MD

Provider Business Mailing Address
First Line	:	PO BOX 108809
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73101-8809
Country	:	US
Telephone Number	:	405-775-9350
Fax Number	:	405-775-9350

Provider Business Practice Location Address
First Line	:	4600 SE 29TH ST
Second Line	:	SUITE 750
City	:	DEL CITY
State	:	OK
Zip	:	73115-3406
Country	:	US
Telephone Number	:	405-733-5900
Fax Number	:	405-733-5905

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

Provider Enumeration Date	:	09/12/2008
Last Update Date	:	12/14/2016

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