Individual
BRIAN W VANDER BOEGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1530 LONE OAK RD, EMERGENCY DEPARTMENT, PADUCAH, KY 42003-7901
(270) 444-2150
(270) 444-2985
Mailing address
PO BOX 636961, CINCINNATI, OH 45263-6961
(513) 981-5130
(513) 981-5015
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
19738
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64197387
—
KY
Enumeration date
09/27/2005
Last updated
06/08/2015
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