Provider Demographics
NPI:1093733727
Name:BOYLE, WALTER A III (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:A
Last Name:BOYLE
Suffix:III
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 1:44791 BAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MENDOCINO
Mailing Address - State:CA
Mailing Address - Zip Code:95460-9527
Mailing Address - Country:US
Mailing Address - Phone:314-324-3425
Mailing Address - Fax:314-362-1185
Practice Address - Street 1:44791 BAYWOOD DR
Practice Address - Street 2:
Practice Address - City:MENDOCINO
Practice Address - State:CA
Practice Address - Zip Code:95460-9527
Practice Address - Country:US
Practice Address - Phone:314-324-3425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.148697207LC0200X
MOR6H50207LC0200X
CAG49981207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202577300Medicaid
ILENROLLEDMedicaid
AR166808001Medicaid
MO003010174Medicaid
IL$$$$$$$$$Medicaid