Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 0103518 | KS |
NPI | 1588672174 |
---|---|
Provider Name | Douglas Lynn Boehr |
First Address | Topeka, KS 66604-3416 |
Second Address | Topeka, KS 66604-3416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T71293 | (02) | KS |