Active NPI
David Boehnke
- Surgical Oncology Physician
- Clark, SD
National Provider Identifier
1134051055
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Oncology Physician
- License
- 10288292
- Practice address
- 1017 Pebble Beach Dr
Clark, SD 57225-1152 - Phone
- (201) 285-7865
- Fax
- (206) 750-9006
- NPI assigned
- Jun 3, 2026
- Last updated
- Jun 3, 2026
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Oncology Physician | 2086X0206X | 10288292 | SD | Primary |
Addresses
Primary practice location
1017 Pebble Beach Dr
Clark, SD 57225-1152
Mailing address
1017 Pebble Beach Dr
Clark, SD 57225-1152
Phone (201) 285-7865
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10288292 | SD | MD | Surgical Oncology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1780444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1780444800000",
"number": "1134051055",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1017 PEBBLE BEACH DR",
"city": "CLARK",
"state": "SD",
"postal_code": "572251152",
"telephone_number": "201-285-7865",
"fax_number": "206-750-9006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1017 PEBBLE BEACH DR",
"city": "CLARK",
"state": "SD",
"postal_code": "572251152",
"telephone_number": "201-285-7865",
"fax_number": "206-750-9006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOEHNKE",
"first_name": "DAVID",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-06-03",
"last_updated": "2026-06-03",
"certification_date": "2026-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "2086X0206X",
"taxonomy_group": "",
"desc": "Surgery, Surgical Oncology",
"state": "SD",
"license": "10288292",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clark, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.