Provider Demographics
NPI:1790759926
Name:BOYER, SHARON LOUISE (DO)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:LOUISE
Last Name:BOYER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4824 E BASELINE RD
Mailing Address - Street 2:SUITE 132
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4676
Mailing Address - Country:US
Mailing Address - Phone:480-969-5613
Mailing Address - Fax:480-844-0622
Practice Address - Street 1:4824 EAST BASELINE RD
Practice Address - Street 2:SUITE 132
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206
Practice Address - Country:US
Practice Address - Phone:480-969-5613
Practice Address - Fax:480-844-0622
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4163207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ101284Medicare PIN
AZY28037Medicare UPIN