MEDICARE: DR. CODY BOYD AULL D.O.

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	207Y00000X	Otolaryngology Physician	23702	MS
2	207YS0123X	Facial Plastic Surgery Physician	23702	MS
3	207Y00000X	Otolaryngology Physician	17340	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2007034875	OTHER	MO	STATE OF MISSOURI

General Provider Information

NPI Number	:	1619150349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CODY BOYD AULL D.O.

Provider Business Mailing Address
First Line	:	5929 BALCONES DR STE 200
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-4280
Country	:	US
Telephone Number	:	512-689-4703
Fax Number	:	877-647-0202

Provider Business Practice Location Address
First Line	:	1515 N FLAGLER DR STE 600
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-3430
Country	:	US
Telephone Number	:	561-513-6342
Fax Number	:	561-513-6343

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

Provider Enumeration Date	:	12/17/2007
Last Update Date	:	03/25/2024

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