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NPI Code Detail

MEDICARE: EDLYNE BOYER

MEDICARE: EDLYNE BOYER
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
1246ZE0600XElectroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number : 1770981177
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDLYNE BOYER
Provider Business Mailing Address
First Line : 4 E CLARK BASS BLVD STE 205
Second Line :
City : MCALESTER
State : OK
Zip : 74501-4285
Country : US
Telephone Number : 918-421-8897
Fax Number : 918-302-0825
Provider Business Practice Location Address
First Line : 4 E CLARK BASS BLVD STE 205
Second Line :
City : MCALESTER
State : OK
Zip : 74501-4285
Country : US
Telephone Number : 918-421-8897
Fax Number : 918-302-0825
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2014
Last Update Date : 12/17/2014

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Directions to “ EDLYNE BOYER ” Practice Location

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