Healthcare Provider Details

I. General information

NPI: 1841296696
Provider Name (Legal Business Name): JEFFREY G BOYLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4424 E FLAMINGO AVE STE 220
NAMPA ID
83687-9291
US

IV. Provider business mailing address

PO BOX 190930
BOISE ID
83719-0930
US

V. Phone/Fax

Practice location:
  • Phone: 208-302-1100
  • Fax: 208-302-1155
Mailing address:
  • Phone: 82-367-5170
  • Fax: 82-367-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number5300
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberM-17456
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: