Provider Demographics
NPI:1023041514
Name:BOERGER, ALAN RAYMOND (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:RAYMOND
Last Name:BOERGER
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 1:1620 LAUREL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-9500
Mailing Address - Country:US
Mailing Address - Phone:937-667-4612
Mailing Address - Fax:937-667-6479
Practice Address - Street 1:1440 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-2804
Practice Address - Country:US
Practice Address - Phone:937-667-4612
Practice Address - Fax:937-667-6479
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2142103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0414886Medicaid
OH0414886Medicaid