Provider Demographics
NPI:1275746638
Name:BOEHM, KEVIN SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:SCOTT
Last Name:BOEHM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 S 88TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9417
Mailing Address - Country:US
Mailing Address - Phone:303-666-7119
Mailing Address - Fax:303-666-0220
Practice Address - Street 1:1044 S 88TH ST STE 2
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9417
Practice Address - Country:US
Practice Address - Phone:303-666-7119
Practice Address - Fax:303-666-0220
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42507207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine