Dr. Mark J Boerner
Ophthalmologist
111 W Main St Ste 200
Boise
, Idaho 83702-7308
Dr. Mark J Boerner
Ophthalmologist
111 W Main St Ste 200
Boise
, Idaho 83702-7308
(208) 344-0461
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About
Features
Specialties
- Ophthalmologist
Languages spoken
- English
Location
First Address
- Dr. Mark J Boerner
- 111 W Main St Ste 200
- Boise, ID
- Zip : 83702-7308
- Fax : (208) 344-0461
- Phone : (208) 344-3220
Second Address
- Dr. Mark J Boerner
- 111 W Main St Ste 200
- Boise, ID
- Zip : 83702-7308
- Fax : (208) 344-0461
- Phone : (208) 344-3220
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207W00000X | Ophthalmologist | M7206 | ID |
National Provider Identifier
| NPI | 1003819459 |
|---|---|
| Provider Name | Dr. Mark J Boerner |
| First Address | Boise, ID 83702-7308 |
| Second Address | Boise, ID 83702-7308 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 31/05/2005 |
| Last Update Date | 15/04/2020 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 000010002554 | REGENCE BLUE SHIELD (01) | ID |
| 1317920001 | DMERC (01) | ID |
| 180038677 | RAILROAD MEDICARE (01) | ID |
| 804243800 | (05) | ID |
| F36656 | (02) | ID |
| J5164 | BLUE CROSS (01) | ID |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.