Provider Demographics
NPI:1851303366
Name:BOEHM, ALAN P JR (DPM)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:P
Last Name:BOEHM
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 E MILLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609
Mailing Address - Country:US
Mailing Address - Phone:919-850-9111
Mailing Address - Fax:919-850-2499
Practice Address - Street 1:1418 E MILLBROOK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4812
Practice Address - Country:US
Practice Address - Phone:919-850-9111
Practice Address - Fax:919-850-2499
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC490213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist