Provider Demographics
NPI:1154309375
Name:BOEHMKE, JAMES JOSEPH JR (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOSEPH
Last Name:BOEHMKE
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1920 MOORES LN STE A
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-4660
Mailing Address - Country:US
Mailing Address - Phone:903-792-8030
Mailing Address - Fax:903-793-0844
Practice Address - Street 1:1920 MOORES LN STE A
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4660
Practice Address - Country:US
Practice Address - Phone:903-792-8030
Practice Address - Fax:903-793-0844
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201412207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology