MEDICARE: DR. BOYER COLE ND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath	ND-63	CA

General Provider Information

NPI Number	:	1679991517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BOYER COLE ND

Provider Business Mailing Address
First Line	:	25A SAN ANSELMO AVE
Second Line	:
City	:	SAN ANSELMO
State	:	CA
Zip	:	94960-2842
Country	:	US
Telephone Number	:	415-721-7453
Fax Number	:	415-721-7454

Provider Business Practice Location Address
First Line	:	25A SAN ANSELMO AVE
Second Line	:
City	:	SAN ANSELMO
State	:	CA
Zip	:	94960-2842
Country	:	US
Telephone Number	:	415-721-7453
Fax Number	:	415-721-7454

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2014
Last Update Date	:	03/28/2014

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