Individual
KEVIN M BOERNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
410 CELEBRATION PLACE, SUITE 200, CELEBRATION, FL 34747-5432
(407) 303-4673
(407) 398-0050
Mailing address
410 CELEBRATION PLACE, SUITE 200, CELEBRATION, FL 34747-5432
(407) 303-4673
(855) 834-5435
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA1628
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
290145500
—
FL
Enumeration date
09/12/2005
Last updated
01/14/2014
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