Provider Demographics
NPI:1952756546
Name:BOEHM, KARL EDWARD (DO)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:EDWARD
Last Name:BOEHM
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 1:1233 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2926
Mailing Address - Country:US
Mailing Address - Phone:307-577-7201
Mailing Address - Fax:307-333-6912
Practice Address - Street 1:1233 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2926
Practice Address - Country:US
Practice Address - Phone:307-577-7201
Practice Address - Fax:307-333-6912
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY12192A207P00000X
WYTL5750207P00000X
KYTP129207P00000X
TXR5702207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine