Provider Demographics
NPI:1629089628
Name:BOYLES, CORY D (MD)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:D
Last Name:BOYLES
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 1:1531 ESPLANADE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3310
Mailing Address - Country:US
Mailing Address - Phone:530-332-6337
Mailing Address - Fax:530-893-6936
Practice Address - Street 1:1531 ESPLANADE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3310
Practice Address - Country:US
Practice Address - Phone:530-332-6337
Practice Address - Fax:530-893-6936
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5941300-1205207P00000X
CAG73848207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00314404OtherMEDICARE RAILROAD
CA00G738480Medicaid
UT59413001200001OtherBLUE CROSS BLUE SHIELD
UTP00438624OtherRAILROAD MEDICARE
UT1629089628Medicaid
UT1629089628Medicaid
UT59413001200001OtherBLUE CROSS BLUE SHIELD
CA00G738480Medicaid
UT000061673Medicare PIN