Healthcare Provider Details

I. General information

NPI: 1063518066
Provider Name (Legal Business Name): THOMAS MARTIN BOYLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 W FLORIDA ST
DEMING NM
88030-4558
US

IV. Provider business mailing address

850 W FLORIDA ST
DEMING NM
88030-4558
US

V. Phone/Fax

Practice location:
  • Phone: 575-544-2020
  • Fax: 575-544-2801
Mailing address:
  • Phone: 575-544-2020
  • Fax: 575-544-2801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2002-0264
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number44014
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: