Active NPI
Brian Douglas Boehman, PHD
- School Psychologist
- Panama City, FL
National Provider Identifier
1770894933
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- SS 988
- Practice address
- 119 W 23Rd St
Panama City, FL 32405-4504 - Phone
- (850) 624-6365
- NPI assigned
- Jun 23, 2010
- Last updated
- Jun 7, 2013
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | SS 988 | FL | |
| School Psychologist | 103TS0200X | SS 988 | FL | Primary |
Addresses
Primary practice location
119 W 23Rd St
Panama City, FL 32405-4504
Mailing address
PO Box 1395
Panama City, FL 32402-1395
Phone (850) 624-6365
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SS 988 | FL | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370563200000",
"number": "1770894933",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1395",
"city": "PANAMA CITY",
"state": "FL",
"postal_code": "324021395",
"telephone_number": "850-624-6365"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "119 W 23RD ST",
"city": "PANAMA CITY",
"state": "FL",
"postal_code": "324054504",
"telephone_number": "850-624-6365"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOEHMAN",
"first_name": "BRIAN",
"middle_name": "DOUGLAS",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-06-23",
"last_updated": "2013-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "FL",
"license": "SS 988",
"primary": false
},
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "FL",
"license": "SS 988",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Panama City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.