Provider Demographics
NPI:1417148818
Name:BOYER, WIL (HIS)
Entity Type:Individual
Prefix:
First Name:WIL
Middle Name:
Last Name:BOYER
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26222 RR 12
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-4903
Mailing Address - Country:US
Mailing Address - Phone:512-858-0300
Mailing Address - Fax:512-858-2714
Practice Address - Street 1:5505 FM 1960 RD W STE 516
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4300
Practice Address - Country:US
Practice Address - Phone:281-587-0444
Practice Address - Fax:281-866-7696
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50438237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX50438OtherTEXAS LICENSE NUMBER
TX2038184-01Medicaid