Basic Information
| Provider Information | |||||||||
| NPI: | 1215460183 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOEHME | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 E 5TH ST STE 400 | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757013362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035963500 | ||||||||
| FaxNumber: | 9035963536 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 E 5TH ST STE 400 | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757013362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0359635009 | ||||||||
| FaxNumber: | 9035963536 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2017 | ||||||||
| LastUpdateDate: | 07/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | S5562 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.