Provider Demographics
NPI:1376501015
Name:BOYER, DAN J (CLINICAL SOCIAL WORK)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:J
Last Name:BOYER
Suffix:
Gender:M
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3203 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-4427
Mailing Address - Country:US
Mailing Address - Phone:812-373-2700
Mailing Address - Fax:812-373-2710
Practice Address - Street 1:3203 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-4427
Practice Address - Country:US
Practice Address - Phone:812-373-2700
Practice Address - Fax:812-373-2710
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003859A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000219051OtherBLUE CROSS ANTHEM
IN000000984113OtherANTHEM PIN
080148475OtherRAILROAD MEDICARE PIN
IN34003859AOtherIN MEDICAL LICENSE
IN1407861164OtherGROUP NPI
IN000000984113OtherANTHEM PIN
080148475OtherRAILROAD MEDICARE PIN