Provider Demographics
NPI:1689657488
Name:BOYER, LENNIS K (MD)
Entity Type:Individual
Prefix:
First Name:LENNIS
Middle Name:K
Last Name:BOYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 SE PROFESSIONAL MALL BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5423
Mailing Address - Country:US
Mailing Address - Phone:509-332-2605
Mailing Address - Fax:509-334-5754
Practice Address - Street 1:1205 SE PROFESSIONAL MALL BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5423
Practice Address - Country:US
Practice Address - Phone:509-332-2605
Practice Address - Fax:509-334-5754
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD0027662208000000X
IDM5747208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8124323Medicaid
WAAB28381Medicare ID - Type Unspecified
WA8124323Medicaid