Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 53963 | MA |
NPI | 1003805144 |
---|---|
Provider Name | John J Boyle |
First Address | Waltham, MA 02451-1991 |
Second Address | Danvers, MA 01923-2567 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2005 |
Last Update Date | 08/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
053963 | TUFTS (01) | MA |
17787 | HPHC (01) | MA |
B97776 | (02) | |
J04044 | BCBS (01) | MA |