Provider Demographics
NPI:1427261429
Name:BOEHM, PETER ERIC JR (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ERIC
Last Name:BOEHM
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1010 E 3RD ST STE 202
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2174
Mailing Address - Country:US
Mailing Address - Phone:423-265-2233
Mailing Address - Fax:423-756-8265
Practice Address - Street 1:1010 E 3RD ST STE 202
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2174
Practice Address - Country:US
Practice Address - Phone:423-265-2233
Practice Address - Fax:423-756-8265
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000046924207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1524932Medicaid
TN3373215Medicare PIN
TN4313010001Medicare NSC