Provider Demographics
NPI:1578763496
Name:BOEHMLER, JAMES H IV (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:BOEHMLER
Suffix:IV
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 1:8601 CANTERA WAY
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-1133
Mailing Address - Country:US
Mailing Address - Phone:682-200-8580
Mailing Address - Fax:682-200-8581
Practice Address - Street 1:1250 8TH AVE STE 265
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4124
Practice Address - Country:US
Practice Address - Phone:682-200-8580
Practice Address - Fax:682-200-8581
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6054208200000X, 2086S0122X
OH35091519208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2840368Medicaid
OH2840368Medicaid