Provider Demographics
NPI:1659566339
Name:SHARON L. BOYER DO PLLC
Entity Type:Organization
Organization Name:SHARON L. BOYER DO PLLC
Other - Org Name:ATHENA WOMENS MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-969-5613
Mailing Address - Street 1:4824 E BASELINE RD STE 140
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4680
Mailing Address - Country:US
Mailing Address - Phone:480-969-5613
Mailing Address - Fax:480-844-0622
Practice Address - Street 1:4824 E BASELINE RD STE 140
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4680
Practice Address - Country:US
Practice Address - Phone:480-969-5613
Practice Address - Fax:480-844-0622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4163207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6427740001Medicare NSC
AZZ101283Medicare PIN