Provider Demographics
NPI:1205849809
Name:BOEKE, DENNIS M (DO)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:M
Last Name:BOEKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-3011
Mailing Address - Country:US
Mailing Address - Phone:417-328-6501
Mailing Address - Fax:417-328-6338
Practice Address - Street 1:1521 S 3RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:MO
Practice Address - Zip Code:65785-9608
Practice Address - Country:US
Practice Address - Phone:417-276-5131
Practice Address - Fax:417-276-6498
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODO107694207Q00000X
MO107694207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00062527OtherPALMETTO GBA RAILRAOD
MOP00062527OtherPALMETTO GBA RAILRAOD
MOF99897Medicare UPIN