Provider Demographics
NPI:1669459921
Name:BOYLES, CASEY J (MD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:J
Last Name:BOYLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2375 EDGEWOOD RD SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-4736
Mailing Address - Country:US
Mailing Address - Phone:319-396-1983
Mailing Address - Fax:319-396-3183
Practice Address - Street 1:2375 EDGEWOOD RD SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-4736
Practice Address - Country:US
Practice Address - Phone:319-396-1983
Practice Address - Fax:319-396-3183
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2012-05-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA33714207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5203042Medicaid
IA2203042Medicaid
IA1669459921Medicaid
IA3203042Medicaid
IA080176890OtherRR MEDICARE
IA2203042Medicaid
IA1669459921Medicaid