Boerje A. Axelsson, M.D.

Key facts

NPI

1831174192

Entity type

Individual (NPI type 1)

Primary specialty

Family Medicine Physician 207Q00000X

License

13435 (OK)

Practice address

30011 E State Highway 51
Coweta, OK 74429-7681

Phone

(918) 486-2161

NPI assigned

Dec 9, 2005

Sex

Male

Sole proprietor

No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Springer Clinic Inc Multi-Specialty Clinic/Center · Tulsa, OK · NPI 1316949860
  NPD (past)

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

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 29, 2008.

{
    "created_epoch": "1134086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204243200000",
    "number": "1831174192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 S YALE AVE",
            "address_2": "STE 1400",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741363310",
            "telephone_number": "918-488-6001",
            "fax_number": "918-488-6010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30011 E STATE HIGHWAY 51",
            "city": "COWETA",
            "state": "OK",
            "postal_code": "744297681",
            "telephone_number": "918-486-2161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AXELSSON",
        "first_name": "BOERJE",
        "middle_name": "A.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-09",
        "last_updated": "2008-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "13435",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Coweta, OK · Family Medicine Physician in Oklahoma