Healthcare Provider Details

I. General information

NPI: 1679548341
Provider Name (Legal Business Name): AMY L. O'BOYLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY L CORY MD

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 03/23/2024
Certification Date: 03/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 LILLY RD NE
OLYMPIA WA
98506-5028
US

IV. Provider business mailing address

PO BOX 3360
PORTLAND OR
97208-3360
US

V. Phone/Fax

Practice location:
  • Phone: 360-486-6772
  • Fax: 360-455-7405
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD60776453
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberMD60776453
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: