MEDICARE: DR. ROBERT LEE BOYLES 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	207Q00000X	Family Medicine Physician	4054	OK

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

General Provider Information

NPI Number	:	1689606964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT LEE BOYLES D.O.

Provider Business Mailing Address
First Line	:	20 E 34TH ST
Second Line	:
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-4001
Country	:	US
Telephone Number	:	918-245-9675
Fax Number	:	918-245-9679

Provider Business Practice Location Address
First Line	:	20 E 34TH ST
Second Line	:
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-4001
Country	:	US
Telephone Number	:	918-245-9675
Fax Number	:	918-245-9679

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	05/01/2014

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