Provider Demographics
NPI:1104811058
Name:BOYER, AARON TAYLOR (MD)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:TAYLOR
Last Name:BOYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8211 S HIDDEN POINT RD
Mailing Address - Street 2:
Mailing Address - City:GLASFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61533-9682
Mailing Address - Country:US
Mailing Address - Phone:309-634-1091
Mailing Address - Fax:
Practice Address - Street 1:2416 S FALCON BLVD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61607-5004
Practice Address - Country:US
Practice Address - Phone:309-633-5255
Practice Address - Fax:309-633-5304
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-1144902083A0100X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036114490OtherLICENSE
ILOTH000Medicare UPIN