Provider Demographics
NPI:1306289087
Name:BOYER, MICAH (MD)
Entity type:Individual
Prefix:DR
First Name:MICAH
Middle Name:
Last Name:BOYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4404 TOBAGO
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-4026
Mailing Address - Country:US
Mailing Address - Phone:940-397-5425
Mailing Address - Fax:940-397-5484
Practice Address - Street 1:501 MIDWESTERN PKWY E
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76302-2302
Practice Address - Country:US
Practice Address - Phone:940-397-5425
Practice Address - Fax:940-397-5484
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2517207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX343867303Medicaid
TX343867303Medicaid