MEDICARE: DR. JAMES LEE BOYSEN M.D.

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	174400000X	Specialist	G6456	TX
2	207R00000X	Internal Medicine Physician	G-6456	TX
3	207RP1001X	Pulmonary Disease Physician	G-6456	TX
4	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	G-6456	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699779330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES LEE BOYSEN M.D.

Provider Business Mailing Address
First Line	:	8708 MENDOCINO DRIVE
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78735
Country	:	US
Telephone Number	:	512-422-5326
Fax Number	:	512-462-6709

Provider Business Practice Location Address
First Line	:	1106 WEST. DITTMAR
Second Line	:	TEXAS NEURO REHAB CENTER
City	:	AUSTIN
State	:	TX
Zip	:	78745
Country	:	US
Telephone Number	:	512-442-5326
Fax Number	:	512-462-6709

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	07/12/2012

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