Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | MD010890E | PA |
NPI | 1720388648 |
---|---|
Provider Name | Edward Gene Boyer |
First Address | Hooversville, PA 15936 |
Second Address | Hooversville, PA 15936 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2010 |
Last Update Date | 26/10/2010 |