Provider Demographics
NPI:1437106242
Name:BOYCE, CORY A (MD)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:A
Last Name:BOYCE
Suffix:
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 1:802 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55975-1024
Mailing Address - Country:US
Mailing Address - Phone:507-346-7373
Mailing Address - Fax:
Practice Address - Street 1:802 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55975-1024
Practice Address - Country:US
Practice Address - Phone:507-346-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48624207Q00000X
MN41583207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34704700Medicaid
WI34704700Medicaid