Basic Information
| Provider Information | |||||||||
| NPI: | 1396979233 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOEREMA | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | DANIEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2700 WESTSIDE DR NW | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373123699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234721511 | ||||||||
| FaxNumber: | 4234799202 | ||||||||
| Practice Location | |||||||||
| Address1: | 2700 WESTSIDE DR NW | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373123699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234721511 | ||||||||
| FaxNumber: | 4234799202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2009 | ||||||||
| LastUpdateDate: | 05/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | 48313 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
No ID Information.