Individual
DR. MARK J BOERNER
Active
Individual
DR. MARK J BOERNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
M7206
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010002554
REGENCE BLUE SHIELD
ID
01
—
1317920001
DMERC
ID
01
—
180038677
RAILROAD MEDICARE
ID
05
—
804243800
—
ID
01
—
J5164
BLUE CROSS
ID
Enumeration date
05/31/2005
Last updated
04/15/2020
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