Healthcare Provider Details

I. General information

NPI: 1801842703
Provider Name (Legal Business Name): MATTHEW ERIC BOYER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E UNIVERSITY AVE DEPT 3414
LARAMIE WY
82071-2000
US

IV. Provider business mailing address

1000 E UNIVERSITY AVE DEPT 3414
LARAMIE WY
82071-2000
US

V. Phone/Fax

Practice location:
  • Phone: 307-766-5071
  • Fax: 307-766-2112
Mailing address:
  • Phone: 307-766-5071
  • Fax: 307-766-2112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number2002013028
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number8867
License Number StateSD
# 3
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number10122A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: