Joyce Boehmer, M.D.

Individual provider Active NPI Internal Medicine Physician · Hazelwood, MO

NPI 1306837752 · NPPES record last updated Feb 8, 2019

Key facts

NPI
1306837752
Entity type
Individual (NPI type 1)
Primary specialty
Internal Medicine Physician 207R00000X
License
36067 (MO)
Practice address
637 Dunn Rd Ste 170
Hazelwood, MO 63042-1759
Phone
(314) 838-5702
Fax
(314) 839-5596
NPI assigned
Nov 3, 2005
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 36067 MO Yes

Addresses

Primary practice location

637 Dunn Rd Ste 170
Hazelwood, MO 63042-1759

Mailing address

PO Box 23340
Saint Louis, MO 63156-3340
Phone (314) 838-5702

Other identifiers

IdentifierTypeStateIssuer
100053OtherMOHEALTHLINK
0400396OtherMOUHC
127462OtherMOGHP
000000010008OtherMOESSENCE
92215275OtherBLUE SHIELD
B18635OtherMOMERCY
4000106OtherMOAETNA
28788OtherMOBCBS

Other providers in Hazelwood, MO

All providers in Hazelwood, MO · Internal Medicine Physician in Missouri

Sources for this page

Verify at the official NPI Registry.