Provider Demographics
NPI:1831532217
Name:BOEMER, ALLISON BETH (MD)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:BETH
Last Name:BOEMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 WATERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5229
Mailing Address - Country:US
Mailing Address - Phone:352-343-2364
Mailing Address - Fax:352-253-0022
Practice Address - Street 1:1210 WATERMAN WAY
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5229
Practice Address - Country:US
Practice Address - Phone:352-343-2364
Practice Address - Fax:352-253-0022
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.36915208800000X
FLME142814208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL226108Medicaid
AL218921Medicaid
AL6942025OtherBCBS ALABAMA