Healthcare Provider Details

I. General information

NPI: 1033229182
Provider Name (Legal Business Name): RICHARD S BOYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MEDICAL DR
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-1900
  • Fax: 801-662-1810
Mailing address:
  • Phone: 801-891-9931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number162085-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: