Provider Demographics
NPI:1801842703
Name:BOYER, MATTHEW ERIC (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ERIC
Last Name:BOYER
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 1:1000 E UNIVERSITY AVE DEPT 3414
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82071-2000
Mailing Address - Country:US
Mailing Address - Phone:307-766-5071
Mailing Address - Fax:307-766-2112
Practice Address - Street 1:1000 E UNIVERSITY AVE DEPT 3414
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82071-2000
Practice Address - Country:US
Practice Address - Phone:307-766-5071
Practice Address - Fax:307-766-2112
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002013028207PS0010X
SD8867207PS0010X
WY10122A207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1801842703Medicaid
KS200364770BMedicaid
H19847Medicare UPIN
MO1801842703Medicaid