Provider Demographics
NPI:1306879994
Name:MAGNUSON BOYLE, SHARYL (MD)
Entity type:Individual
Prefix:
First Name:SHARYL
Middle Name:
Last Name:MAGNUSON BOYLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHARYL
Other - Middle Name:MAGNUSON
Other - Last Name:BOYLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1010 SW COAST HWY STE 203
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-5215
Mailing Address - Country:US
Mailing Address - Phone:541-265-4947
Mailing Address - Fax:541-574-7670
Practice Address - Street 1:1010 SW COAST HWY STE 203
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-5215
Practice Address - Country:US
Practice Address - Phone:541-265-4947
Practice Address - Fax:541-574-7670
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2021-11-30
Deactivation Date:2019-08-12
Deactivation Code:
Reactivation Date:2019-08-16
Provider Licenses
StateLicense IDTaxonomies
NM89-252207Q00000X
ORMD27207207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM21329Medicaid
NM21329Medicaid
A13142Medicare UPIN