Individual
DR. DOUGLAS KENT BOEHM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
640 JACKSON ST, SAINT PAUL, MN 55101
(651) 254-4887
Mailing address
8170 33RD AVE S # MS 21110Q, MINNEAPOLIS, MN 55425-4516
(651) 254-4887
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
65012
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003605800
—
ID
Enumeration date
09/26/2005
Last updated
02/07/2019
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