Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PS005956L | PA |
Y | 103T00000X | Psychologist | PS005956L | PA |
NPI | 1013059831 |
---|---|
Provider Name | Bret A Boyer |
First Address | Darby, PA 19023 |
Second Address | Darby, PA 19023-1330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0014740920001 | (05) | PA |
023305 | HIGHMARK (01) | PA |
0659085000 | PERSONAL CHOICE (01) | PA |
5657127 | AETNA (01) | PA |