Healthcare Provider Details

I. General information

NPI: 1629089628
Provider Name (Legal Business Name): CORY D BOYLES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 ESPLANADE
CHICO CA
95926-3310
US

IV. Provider business mailing address

1531 ESPLANADE
CHICO CA
95926-3310
US

V. Phone/Fax

Practice location:
  • Phone: 530-332-6337
  • Fax: 530-893-6936
Mailing address:
  • Phone: 530-332-6337
  • Fax: 530-893-6936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5941300-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG73848
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: