Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 00022702 | AL |
NPI | 1023016888 |
---|---|
Provider Name | John William Boyer |
First Address | Mobile, AL 36607-2301 |
Second Address | Mobile, AL 36607-2301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 11/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000008971 | (05) | AL |
510-08971 | BLUE CROSS BLUE SHIELD (01) | AL |
G92034 | (02) |