Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 7154 | SD |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | OS013636 | PA |
Y | 2081P2900X | Pain Medicine | 7154 | SD |
NPI | 1043276645 |
---|---|
Provider Name | Dr. Thomas Matthew Boetel |
First Address | Sioux Falls, SD 57117-5074 |
Second Address | Sioux Falls, SD 57104-9890 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2006 |
Last Update Date | 17/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I14912 | (02) |