Healthcare Provider Details

I. General information

NPI: 1184630816
Provider Name (Legal Business Name): PATRICK JAMES BOYLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 NW HWY 101 SUITE A
DEPOE BAY OR
97341
US

IV. Provider business mailing address

539 NW HWY 101 SUITE A
DEPOE BAY OR
97341
US

V. Phone/Fax

Practice location:
  • Phone: 541-765-3265
  • Fax:
Mailing address:
  • Phone: 541-765-3265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD29083
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: