Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 104448 | NY |
NPI | 1003850876 |
---|---|
Provider Name | Dr. Ronald B Boersma |
First Address | Orchard Park, NY 14127-1718 |
Second Address | Orchard Park, NY 14127-1718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 02/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00589886 | (05) | NY |
B35993 | (02) | NE |
P00275983 | CHS RAILROAD MEDICARE (01) | NY |