MEDICARE: DEREK A BOYER PA

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	363AM0700X	Medical Physician Assistant	PA 9107230	FL
2	363A00000X	Physician Assistant	0010-06304	NC

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	:	1790123743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK A BOYER PA

Provider Business Mailing Address
First Line	:	1834 SW 1ST AVE
Second Line	:	SUITE 201
City	:	OCALA
State	:	FL
Zip	:	34471-8100
Country	:	US
Telephone Number	:	352-732-9888
Fax Number	:	352-732-0490

Provider Business Practice Location Address
First Line	:	322 MULBERRY ST SW STE A
Second Line	:
City	:	LENOIR
State	:	NC
Zip	:	28645-5703
Country	:	US
Telephone Number	:	828-757-6460
Fax Number	:	828-759-4901

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

Provider Enumeration Date	:	06/12/2013
Last Update Date	:	03/14/2019

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Directions to “ DEREK A BOYER PA” Practice Location

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