Provider Demographics
NPI:1003869694
Name:BOEDING, MARVIN A (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:A
Last Name:BOEDING
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1762 HOFFMAN DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4292
Mailing Address - Country:US
Mailing Address - Phone:970-663-3030
Mailing Address - Fax:970-663-3041
Practice Address - Street 1:1762 HOFFMAN DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4292
Practice Address - Country:US
Practice Address - Phone:970-663-3030
Practice Address - Fax:970-663-3041
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO612103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO87746Medicare ID - Type Unspecified