Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 02714 | KY |
Y | 207T00000X | Neurosurgeon | 036-125876 | IL |
NPI | 1083785075 |
---|---|
Provider Name | Jerrel H Boyer |
First Address | Chicago, IL 60657-5194 |
Second Address | Chicago, IL 60657-5194 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 31/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64034762 | (05) | KY |