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NPI Code Detail

MEDICARE: ROBERT E BOYACK

MEDICARE: ROBERT E BOYACK
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
11041C0700XClinical Social WorkerISW 2846FL
21041C0700XClinical Social WorkerHI

General Provider Information

NPI Number : 1851583769
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT E BOYACK
Provider Business Mailing Address
First Line : 91-1841 FORT WEAVER RD
Second Line :
City : EWA BEACH
State : HI
Zip : 96706-1909
Country : US
Telephone Number : 808-681-3500
Fax Number :
Provider Business Practice Location Address
First Line : 91-1841 FORT WEAVER RD
Second Line :
City : EWA BEACH
State : HI
Zip : 96706-1909
Country : US
Telephone Number : 808-681-3500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2007
Last Update Date : 05/08/2017

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Directions to “ ROBERT E BOYACK ” Practice Location

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