Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 36002426 | OH |
Y | 222Z00000X | Podiatrist | 36002426 | OH |
N | 213EP1101X | Primary Podiatric Medicine | 36002426 | OH |
NPI | 1447251624 |
---|---|
Provider Name | Dr. Michael J. Boyer |
First Address | Wadsworth, OH 44281-2286 |
Second Address | Wadsworth, OH 44281-1851 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 02/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0696751 | (05) | OH |
T96112 | (02) | OH |