Provider Demographics
NPI:1972512259
Name:JAMES L. BOERNER MD PC
Entity Type:Organization
Organization Name:JAMES L. BOERNER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOERNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-890-2442
Mailing Address - Street 1:507 HIGHLAND TER
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2479
Mailing Address - Country:US
Mailing Address - Phone:615-890-2442
Mailing Address - Fax:615-849-9264
Practice Address - Street 1:507 HIGHLAND TER
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2479
Practice Address - Country:US
Practice Address - Phone:615-890-2442
Practice Address - Fax:615-849-9264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD13366207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMD13366OtherMD LICENSE