Healthcare Provider Details

I. General information

NPI: 1639456064
Provider Name (Legal Business Name): SUSAN K BOYER, MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9890 CLAYTON RD SUITE 100
SAINT LOUIS MO
63124-1685
US

IV. Provider business mailing address

9890 CLAYTON RD SUITE 100
SAINT LOUIS MO
63124-1685
US

V. Phone/Fax

Practice location:
  • Phone: 314-725-1515
  • Fax: 314-222-6321
Mailing address:
  • Phone: 314-725-1515
  • Fax: 314-222-6321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number103713
License Number StateMO

VIII. Authorized Official

Name: DR. SUSAN BOYER
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 314-725-1515