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Individual

DR. CARL DAVID BOETHEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-2111
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-8800

Taxonomy

Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
L9629
TX
207RS0012X
Sleep Medicine (Internal Medicine) Physician
L9629
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1683856-01
CSHCN
TX
05
1683856-01
TX
01
8P9110
BLUE SHIELD
TX
01
P00184712
RR/MEDICARE
TX
Enumeration date
03/21/2006
Last updated
12/03/2021
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