Individual
ANDREW M. BOUGHAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
530 9TH ST, FLORENCE, OR 97439
(541) 997-7104
(541) 902-7533
Mailing address
530 9TH ST, FLORENCE, OR 97439-7388
(541) 997-7104
(541) 997-5975
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
DO13869
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C90852
UPIN
OR
01
—
DO13869
STATE LICENSE
OR
Enumeration date
05/08/2006
Last updated
12/09/2009
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