Provider Demographics
NPI:1376530949
Name:BOEREN, JOHN J (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:BOEREN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:311 W LINCOLN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1902
Mailing Address - Country:US
Mailing Address - Phone:618-234-2566
Mailing Address - Fax:618-234-5650
Practice Address - Street 1:311 W LINCOLN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1902
Practice Address - Country:US
Practice Address - Phone:618-234-2566
Practice Address - Fax:618-234-5650
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
0150523OtherUNITED HEALTHCARE
08215273OtherBCBS IL
117951OtherHEALTHLINK
127868OtherBCBS MO
80015974OtherRR MEDICARE
166403OtherGROUP HEALTH PLAN
5648285OtherAETNA
0150523OtherUNITED HEALTHCARE
C38041Medicare UPIN