Provider Demographics
NPI:1962937524
Name:BOYETT HEALTHCARE OF TEXAS PLLC
Entity type:Organization
Organization Name:BOYETT HEALTHCARE OF TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-921-5556
Mailing Address - Street 1:7515 GREENVILLE AVE
Mailing Address - Street 2:STE 1000
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3831
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7515 GREENVILLE AVE
Practice Address - Street 2:STE 1000
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3831
Practice Address - Country:US
Practice Address - Phone:205-921-5556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty