Provider Demographics
NPI:1205413218
Name:BOYLE, GRACE MERINAR (DO)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:MERINAR
Last Name:BOYLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10099 RIDGEGATE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5532
Mailing Address - Country:US
Mailing Address - Phone:720-875-2880
Mailing Address - Fax:720-875-2877
Practice Address - Street 1:10099 RIDGEGATE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5532
Practice Address - Country:US
Practice Address - Phone:720-875-2880
Practice Address - Fax:720-875-2877
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL.0008675207R00000X
COTL.00008675390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine