MEDICARE: DR. JONATHAN CHARLES HOYLE PH.D.

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	103TC2200X	Clinical Child & Adolescent Psychologist	31417	TX

General Provider Information

NPI Number	:	1255340840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN CHARLES HOYLE PH.D.

Provider Business Mailing Address
First Line	:	4201 MARATHON BLVD
Second Line	:	SUITE 206
City	:	AUSTIN
State	:	TX
Zip	:	78756-3436
Country	:	US
Telephone Number	:	512-415-9858
Fax Number	:	512-451-3498

Provider Business Practice Location Address
First Line	:	4201 MARATHON BLVD
Second Line	:	SUITE 206
City	:	AUSTIN
State	:	TX
Zip	:	78756-3436
Country	:	US
Telephone Number	:	512-415-9858
Fax Number	:	512-451-3498

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/08/2007

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