Provider Demographics
NPI:1598844839
Name:BOYLE, BRET R (DO)
Entity Type:Individual
Prefix:DR
First Name:BRET
Middle Name:R
Last Name:BOYLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:6508 CANYON COVE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6339
Mailing Address - Country:US
Mailing Address - Phone:801-590-9064
Mailing Address - Fax:801-278-9182
Practice Address - Street 1:1220 E 3900 S STE 3A
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124
Practice Address - Country:US
Practice Address - Phone:801-590-9064
Practice Address - Fax:801-278-9182
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT678075712042083P0011X
UT001168174400000X
UT6780757-12042083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FB0623810OtherDEA NUMBER
FB0623810OtherDEA NUMBER