Provider Demographics
NPI:1518366475
Name:BOE, ERIC (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:BOE
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 1:3750 CONVOY ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3770
Mailing Address - Country:US
Mailing Address - Phone:858-278-8031
Mailing Address - Fax:
Practice Address - Street 1:9101 KANIS RD STE 401
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6450
Practice Address - Country:US
Practice Address - Phone:501-217-3533
Practice Address - Fax:501-217-3578
Is Sole Proprietor?:No
Enumeration Date:2014-08-17
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A17275207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery