Provider Demographics
NPI:1184715401
Name:BOEHME, ELIZABETH Y (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:Y
Last Name:BOEHME
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 BISSONNET ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-2153
Mailing Address - Country:US
Mailing Address - Phone:713-662-2777
Mailing Address - Fax:713-665-6227
Practice Address - Street 1:3400 BISSONNET ST STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-2153
Practice Address - Country:US
Practice Address - Phone:713-662-2777
Practice Address - Fax:713-665-6227
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH4061207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89Y982OtherBLUE CROSS BLUE SHIELD
TX114662303Medicaid
TXP00195922OtherRAILROAD MEDICARE
TXB27720Medicare UPIN
TX114662303Medicaid