Healthcare Provider Details

I. General information

NPI: 1164482287
Provider Name (Legal Business Name): TERESA BOYLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 11/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 E. MLK JR. BLVD.
AUSTIN TX
78702
US

IV. Provider business mailing address

9715 BURNET RD STE 200 BLDG 7
AUSTIN TX
78758-5215
US

V. Phone/Fax

Practice location:
  • Phone: 512-334-2600
  • Fax: 512-623-5290
Mailing address:
  • Phone: 512-334-2654
  • Fax: 512-623-5290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberK8023
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number51483
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: