MEDICARE: DR. WALTER A BOYLE III MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LC0200X	Critical Care Medicine (Anesthesiology) Physician	036.148697	IL
2	207LC0200X	Critical Care Medicine (Anesthesiology) Physician	R6H50	MO
3	207LC0200X	Critical Care Medicine (Anesthesiology) Physician	G49981	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093733727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALTER A BOYLE III MD

Provider Business Mailing Address
First Line	:	44791 BAYWOOD DR
Second Line	:
City	:	MENDOCINO
State	:	CA
Zip	:	95460-9527
Country	:	US
Telephone Number	:	314-324-3425
Fax Number	:	314-362-1185

Provider Business Practice Location Address
First Line	:	44791 BAYWOOD DR
Second Line	:
City	:	MENDOCINO
State	:	CA
Zip	:	95460-9527
Country	:	US
Telephone Number	:	314-324-3425
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	05/11/2022

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