Provider Demographics
NPI:1699779330
Name:BOYSEN, JAMES LEE (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEE
Last Name:BOYSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8708 MENDOCINO DRIVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735
Mailing Address - Country:US
Mailing Address - Phone:512-422-5326
Mailing Address - Fax:512-462-6709
Practice Address - Street 1:1106 WEST. DITTMAR
Practice Address - Street 2:TEXAS NEURO REHAB CENTER
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745
Practice Address - Country:US
Practice Address - Phone:512-442-5326
Practice Address - Fax:512-462-6709
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6456174400000X
TXG-6456207R00000X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133939203Medicaid
TX133939208Medicaid
TXC13684Medicare UPIN
TX133939208Medicaid