Provider Demographics
NPI:1487628160
Name:BOENIG, SANDRA EILEEN (DO)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:EILEEN
Last Name:BOENIG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:EILEEN
Other - Last Name:KUEHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1195 GARNER FIELD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801-4820
Mailing Address - Country:US
Mailing Address - Phone:830-278-3086
Mailing Address - Fax:
Practice Address - Street 1:1195 GARNER FIELD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-4820
Practice Address - Country:US
Practice Address - Phone:830-278-3086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6993208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL6993OtherSTATE LICENSE