Provider Demographics
NPI:1093803116
Name:ROBERT L. BOYNE, M.D., P.A.
Entity Type:Organization
Organization Name:ROBERT L. BOYNE, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:BOYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-596-3808
Mailing Address - Street 1:700 OLYMPIC PLAZA CIR STE 912
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1955
Mailing Address - Country:US
Mailing Address - Phone:903-596-3808
Mailing Address - Fax:903-596-3815
Practice Address - Street 1:700 OLYMPIC PLAZA CIR STE 912
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1955
Practice Address - Country:US
Practice Address - Phone:903-596-3808
Practice Address - Fax:903-596-3814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4260174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154300101Medicaid
TX00955TMedicare PIN