Provider Demographics
NPI:1851403984
Name:ELLIOTT, BOYCE III (MD)
Entity Type:Individual
Prefix:DR
First Name:BOYCE
Middle Name:
Last Name:ELLIOTT
Suffix:III
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 1:4242 MEDICAL DR
Mailing Address - Street 2:SUITE 7100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5640
Mailing Address - Country:US
Mailing Address - Phone:210-308-5533
Mailing Address - Fax:210-308-5933
Practice Address - Street 1:4242 MEDICAL DR
Practice Address - Street 2:SUITE 7100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5640
Practice Address - Country:US
Practice Address - Phone:210-308-5533
Practice Address - Fax:210-308-5933
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD32142084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00TW70Medicare PIN
TXE10938Medicare UPIN