Healthcare Provider Details

I. General information

NPI: 1104811058
Provider Name (Legal Business Name): AARON TAYLOR BOYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 S FALCON BLVD
PEORIA IL
61607-5004
US

IV. Provider business mailing address

8211 S HIDDEN POINT RD
GLASFORD IL
61533-9682
US

V. Phone/Fax

Practice location:
  • Phone: 309-633-5255
  • Fax: 309-633-5304
Mailing address:
  • Phone: 309-634-1091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number036-114490
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-114490
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: