Dr. Roger W. Boe
Adolescent Medicine
405 W Whitman St
Pocatello
, Idaho 83204-3317
Dr. Roger W. Boe
Adolescent Medicine
405 W Whitman St
Pocatello
, Idaho 83204-3317
(208) 233-5651
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About
Features
Specialties
- Adolescent Medicine
Languages spoken
- English
Location
First Address
- Dr. Roger W. Boe
- 226 S 16th Ave
- Pocatello, ID
- Zip : 83201-4003
- Phone : (208) 233-5651
Second Address
- Dr. Roger W. Boe
- 405 W Whitman St
- Pocatello, ID
- Zip : 83204-3317
- Phone : (208) 233-6833
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2080A0000X | Adolescent Medicine | M2691 | ID |
National Provider Identifier
| NPI | 1285797241 |
|---|---|
| Provider Name | Dr. Roger W. Boe |
| First Address | Pocatello, ID 83201-4003 |
| Second Address | Pocatello, ID 83204-3317 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 19/12/2006 |
| Last Update Date | 08/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| E04193 | (02) |
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.