MEDICARE: STEPHEN BOYER 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	207P00000X	Emergency Medicine Physician	MD11924	OR

General Provider Information

NPI Number	:	1699171918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN BOYER MD

Provider Business Mailing Address
First Line	:	3708 SW LYLE CT
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97221-3963
Country	:	US
Telephone Number	:	503-294-0520
Fax Number	:

Provider Business Practice Location Address
First Line	:	3708 SW LYLE CT
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97221-3963
Country	:	US
Telephone Number	:	503-703-5889
Fax Number	:

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

Provider Enumeration Date	:	11/13/2014
Last Update Date	:	11/13/2014

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