Healthcare Provider Details

I. General information

NPI: 1982691762
Provider Name (Legal Business Name): BRYAN BOYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 DORCHESTER CT STE A
GOSHEN IN
46526-6819
US

IV. Provider business mailing address

PO BOX 834
GOSHEN IN
46527-0834
US

V. Phone/Fax

Practice location:
  • Phone: 574-534-2548
  • Fax: 574-534-3622
Mailing address:
  • Phone: 574-364-2592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number01055773A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01055773A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: