Boerne Mens Clinic

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

BOERNE MENS CLINIC

Practice address

138 TX-46
Boerne, TX 78006

Phone

(713) 551-3455

NPI assigned

Sep 1, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Daniel David Waite

Title

Manager

Phone

(469) 682-5323

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1598918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628553600000",
    "number": "1982218517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 TX 46 W",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "760083644",
            "telephone_number": "830-446-5051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 TX-46",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "78006",
            "telephone_number": "713-551-3455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOERNE MENS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-01",
        "last_updated": "2021-08-10",
        "certification_date": "2021-07-19",
        "status": "A",
        "authorized_official_last_name": "WAITE",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "469-682-5323"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR. LIVINGSTON, MD NPI",
            "identifier": "1477547099",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Boerne Eyes on Main PLLC
• Boerne Family Dental PLLC
• Boerne Foot and Ankle PLLC
• Boerne Hearing & Tinnitus PLLC
• Boerne Isd
• Boerne Nursing Operations, LLC
• Boerne OB/GYN, P.a.
• Boerne Operations LLC
• Boerne Optical LTD 1
• Boerne Orthodontics, PLLC

• Family Medicine Physician in Boerne, TX
• Providers in Boerne, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.