Individual
DR. MARK J BOERNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 W MAIN ST STE 200, BOISE, ID 83702-7308
(208) 344-3220
(208) 344-0461
Mailing address
111 W MAIN ST, STE 200, BOISE, ID 83702-7308
(208) 344-3220
(208) 344-0461
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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