1447233267 NPI number — DR. JAMES LORENZEN BOYER M.D.

Table of content: DR. JAMES LORENZEN BOYER M.D. (NPI 1447233267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447233267 NPI number — DR. JAMES LORENZEN BOYER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYER
Provider First Name:
JAMES
Provider Middle Name:
LORENZEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447233267
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 98019, 333 CEDAR ST, 1080 LMP
Provider Second Line Business Mailing Address:
YALE UNIVERSITY SHOOL OF MEDICINE, SECTION OF DIGESTIVE
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06520-8019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-785-7352
Provider Business Mailing Address Fax Number:
203-785-7273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 TEMPLE ST., SUITE 1A
Provider Second Line Business Practice Location Address:
TEMPLE MEDICAL CENTER
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-785-4138
Provider Business Practice Location Address Fax Number:
203-785-6414
Provider Enumeration Date:
11/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  012702 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001127026 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1121026 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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