1518948512 NPI number — ERIC MARTIN BOYDEN M.D.

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	BOYDEN
Provider First Name	:	ERIC
Provider Middle Name	:	MARTIN
Provider Name Prefix Text	:
Provider Name Suffix Text	:
Provider Credential Text	:	M.D.
Provider Gender Code	:	M

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	:	1518948512
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	07/08/2007
NPI Deactivation Reason Code	:
NPI Deactivation Date	:
NPI Reactivation Date	:

Provider First Line Business Mailing Address	:	555 N ARLINGTON AVE
Provider Second Line Business Mailing Address	:
Provider Business Mailing Address City Name	:	RENO
Provider Business Mailing Address State Name	:	NV
Provider Business Mailing Address Postal Code	:	895034723
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	7757863040
Provider Business Mailing Address Fax Number	:	7757861358

Provider First Line Business Practice Location Address	:	555 N ARLINGTON AVE
Provider Second Line Business Practice Location Address	:
Provider Business Practice Location Address City Name	:	RENO
Provider Business Practice Location Address State Name	:	NV
Provider Business Practice Location Address Postal Code	:	895034723
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	7757863040
Provider Business Practice Location Address Fax Number	:	7757861358
Provider Enumeration Date	:	11/08/2005

Authorized Official Last Name	:
Authorized Official First Name	:
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Authorized Official Title or Position	:
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• Taxonomy code: 207X00000X , with the licence number:  6724 , registered in the state of NV .

• Identifier: E59759 , issued by the state of ( NV ) . This identifiers is of the category "".
• Identifier: XPY162230 . This is a "MEDI-CAL PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "".
• Identifier: 20-16625 , issued by the state of ( NV ) . This identifiers is of the category "".
• Identifier: 20WCGXF13 , issued by the state of ( NV ) . This identifiers is of the category "".