Provider Demographics
NPI:1689606964
Name:BOYLES, ROBERT LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEE
Last Name:BOYLES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-4001
Mailing Address - Country:US
Mailing Address - Phone:918-245-9675
Mailing Address - Fax:918-245-9679
Practice Address - Street 1:20 E 34TH ST
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-4001
Practice Address - Country:US
Practice Address - Phone:918-245-9675
Practice Address - Fax:918-245-9679
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4054207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200021800AMedicaid
OK245515204Medicare PIN