Provider Demographics
NPI:1740272400
Name:BOESLER, DAVID ROBERT (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ROBERT
Last Name:BOESLER
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 1:871 NW 85TH TER
Mailing Address - Street 2:# 1719
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1249
Mailing Address - Country:US
Mailing Address - Phone:515-770-4291
Mailing Address - Fax:
Practice Address - Street 1:3200 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2018
Practice Address - Country:US
Practice Address - Phone:954-262-4316
Practice Address - Fax:515-262-3538
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02365204D00000X
FLOS9892204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0274993Medicaid
E09172Medicare UPIN
IA27499Medicare ID - Type Unspecified