Provider Demographics
NPI:1639456064
Name:SUSAN K BOYER, MD LLC
Entity Type:Organization
Organization Name:SUSAN K BOYER, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-725-1515
Mailing Address - Street 1:9890 CLAYTON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1685
Mailing Address - Country:US
Mailing Address - Phone:314-725-1515
Mailing Address - Fax:314-222-6321
Practice Address - Street 1:9890 CLAYTON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1685
Practice Address - Country:US
Practice Address - Phone:314-725-1515
Practice Address - Fax:314-222-6321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103713302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1780733832OtherINDIVIDUAL NPI