Provider Demographics
NPI:1013208149
Name:BOEHLING, NICHOLAS SONG (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:SONG
Last Name:BOEHLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5579
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-5579
Mailing Address - Country:US
Mailing Address - Phone:541-706-5800
Mailing Address - Fax:541-706-6341
Practice Address - Street 1:2500 NE NEFF RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6015
Practice Address - Country:US
Practice Address - Phone:541-706-5800
Practice Address - Fax:541-706-6341
Is Sole Proprietor?:No
Enumeration Date:2011-04-24
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD1769082085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology