Provider Demographics
NPI:1427000785
Name:BOEHM, GERHARD AW (MD)
Entity Type:Individual
Prefix:DR
First Name:GERHARD
Middle Name:AW
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 1:3 MOBILE INFIRMARY CIR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3520
Mailing Address - Country:US
Mailing Address - Phone:251-433-5557
Mailing Address - Fax:251-433-5558
Practice Address - Street 1:3 MOBILE INFIRMARY CIR
Practice Address - Street 2:SUITE 305
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3520
Practice Address - Country:US
Practice Address - Phone:251-433-5557
Practice Address - Fax:251-433-5558
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00006021174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000000549Medicaid
AL000000549Medicaid
AL000000549Medicare PIN