Provider Demographics
NPI:1275535932
Name:BOYCE, RICHARD A (CRNA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:BOYCE
Suffix:
Gender:M
Credentials:CRNA
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 837
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84402-0837
Mailing Address - Country:US
Mailing Address - Phone:801-392-0402
Mailing Address - Fax:801-393-3334
Practice Address - Street 1:3480 WASHINGTON BLVD STE 105
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-4149
Practice Address - Country:US
Practice Address - Phone:801-392-0385
Practice Address - Fax:801-393-3334
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT216384-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTR76158Medicare UPIN