Provider Demographics
NPI:1790123743
Name:BOYER, DEREK A (PA)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:A
Last Name:BOYER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 SW 1ST AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-8100
Mailing Address - Country:US
Mailing Address - Phone:352-732-9888
Mailing Address - Fax:352-732-0490
Practice Address - Street 1:322 MULBERRY ST SW STE A
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5703
Practice Address - Country:US
Practice Address - Phone:828-757-6460
Practice Address - Fax:828-759-4901
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9107230363AM0700X
NC0010-06304363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical