Individual
DR. DOUGLAS LEE BOERTJE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
501 S SHARON AMITY RD STE 300, CHARLOTTE, NC 28211-0035
(704) 377-2424
(704) 377-2687
Mailing address
501 S SHARON AMITY RD STE 300, CHARLOTTE, NC 28211-0035
(704) 377-2424
(704) 377-2687
Taxonomy
Speciality
Code
Description
License number
State
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
Primary
2006-01516
NC
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
36257
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
59-05661
—
NC
01
—
N01517
SC MEDICAID
SC
Enumeration date
07/26/2005
Last updated
08/23/2023
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