Healthcare Provider Details

I. General information

NPI: 1861060592
Provider Name (Legal Business Name): BENJAMIN TRAVIS BOYETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 STATE ST STE 6
NEW ALBANY IN
47150-4972
US

IV. Provider business mailing address

2125 STATE ST STE 6
NEW ALBANY IN
47150-4972
US

V. Phone/Fax

Practice location:
  • Phone: 812-949-5790
  • Fax: 812-949-5931
Mailing address:
  • Phone: 812-949-5790
  • Fax: 812-949-5931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2022024327
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2021022533
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number01100049A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: