Provider Demographics
NPI:1982691762
Name:BOYER, BRYAN (MD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
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:PO BOX 834
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46527-0834
Mailing Address - Country:US
Mailing Address - Phone:574-364-2592
Mailing Address - Fax:
Practice Address - Street 1:1824 DORCHESTER CT STE A
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-6819
Practice Address - Country:US
Practice Address - Phone:574-534-2548
Practice Address - Fax:574-534-3622
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055773A207XX0801X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200393220Medicaid
IN200393220Medicaid
INP00287116OtherRR MEDICARE
IN200393220Medicaid
IN000000378946OtherBCBS BMG ORTHOPEDIC