Provider Demographics
NPI:1124035779
Name:BOYLE, LAWRENCE P JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:P
Last Name:BOYLE
Suffix:JR
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 1:130 MEDICAL CENTER PARKWAY
Mailing Address - Street 2:# 9
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340
Mailing Address - Country:US
Mailing Address - Phone:936-291-7773
Mailing Address - Fax:936-291-7481
Practice Address - Street 1:130 MEDICAL CENTER PKWY
Practice Address - Street 2:# 9
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4942
Practice Address - Country:US
Practice Address - Phone:936-291-7773
Practice Address - Fax:936-291-7481
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1556174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC13681Medicare UPIN
TX00B39PMedicare ID - Type UnspecifiedMEDICARE/BCBS