Provider Demographics
NPI:1730287483
Name:BOYER, CLARK ABILIO (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:ABILIO
Last Name:BOYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 TANGLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-3407
Mailing Address - Country:US
Mailing Address - Phone:956-464-8600
Mailing Address - Fax:956-464-8601
Practice Address - Street 1:702 E EXPRESSWAY 83 STE A3
Practice Address - Street 2:
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-2742
Practice Address - Country:US
Practice Address - Phone:956-464-8600
Practice Address - Fax:956-464-8601
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0019174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4334335OtherBLUE LINK NUMBER (BC/BS)
TXM0019OtherLICENCE
TX175709801Medicaid
TX8R1261OtherBC/BS IDENTIFIER
TX4334335OtherBLUE LINK NUMBER (BC/BS)
TX175709801Medicaid