Basic Information
| Provider Information | |||||||||
| NPI: | 1487628160 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOENIG | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | EILEEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KUEHLER | ||||||||
| OtherFirstName: | SANDRA | ||||||||
| OtherMiddleName: | EILEEN | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DO | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1195 GARNER FIELD RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | UVALDE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788014820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302783086 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1195 GARNER FIELD RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | UVALDE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788014820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302783086 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 11/17/2016 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | L6993 | TX | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | L6993 | 01 | TX | STATE LICENSE | OTHER |