Individual
KENNETH BOOCKVAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
619 19TH ST S, BIRMINGHAM, AL 35249-6508
(205) 731-9701
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
(205) 731-9701
(205) 297-9411
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
45113
AL
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
1967511
NY
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
45113
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01712138
—
NY
Enumeration date
03/10/2006
Last updated
06/29/2023
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