Roger W. Boe, M.D.
Individual provider Active NPI Pediatric Adolescent Medicine Physician · Pocatello, ID
NPI 1285797241 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1285797241
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Adolescent Medicine Physician 2080A0000X
- License
- M2691 (ID)
- Practice address
- 405 W Whitman St
Pocatello, ID 83204-3317 - Phone
- (208) 233-6833
- NPI assigned
- Dec 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091009000069 | ID | Practitioner - Pediatric Medicine | 2466598198 | Practice locations: Pocatello, ID |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M2691 | ID | MD | Pediatric Adolescent Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Adolescent Medicine Physician | 2080A0000X | M2691 | ID | Yes |
Addresses
Primary practice location
405 W Whitman St
Pocatello, ID 83204-3317
Mailing address
226 S 16TH Ave
Pocatello, ID 83201-4003
Phone (208) 233-5651
Other providers in Pocatello, ID
- BMH, Inc.
- BMH, Inc.
- BMH, Inc.
- Joel Bocanegra
- Body & Soul Therapy LLC
- Andrew William Bohnsack
- Jean M Bokelmann
- Patricia Marion Bolinger
- Alice D. Bollinger
- Alina Bonci
All providers in Pocatello, ID · Pediatric Adolescent Medicine Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.