Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0011X | Interventional Cardiology | MD.204685 | LA |
NPI | 1124342159 |
---|---|
Provider Name | Dr. Ryan David Boehm |
First Address | Miami, FL 33169-5710 |
Second Address | New Orleans, LA 70122-3854 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2010 |
Last Update Date | 10/03/2021 |