Provider Demographics
NPI:1861641961
Name:BOECKMAN, MATTHEW J (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:BOECKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 108809
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73101-8809
Mailing Address - Country:US
Mailing Address - Phone:405-775-9350
Mailing Address - Fax:405-775-9350
Practice Address - Street 1:4600 SE 29TH ST
Practice Address - Street 2:SUITE 750
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-3406
Practice Address - Country:US
Practice Address - Phone:405-733-5900
Practice Address - Fax:405-733-5905
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29617207LP2900X
PAMD446546207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine