Healthcare Provider Details

I. General information

NPI: 1295865590
Provider Name (Legal Business Name): WILLIAM HENRY BOYCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 COUCH AVE
ST LOUIS MO
63122
US

IV. Provider business mailing address

6814 KINGBURY
ST LOUIS MO
63130
US

V. Phone/Fax

Practice location:
  • Phone: 314-721-1531
  • Fax: 314-822-6316
Mailing address:
  • Phone: 314-721-1531
  • Fax: 314-822-6316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number036-126153
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA10320
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: