Provider Demographics
NPI:1922030394
Name:OLIVER, BOYCE B (MD)
Entity Type:Individual
Prefix:
First Name:BOYCE
Middle Name:B
Last Name:OLIVER
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 1:1303 MCCULLOUGH AVE
Mailing Address - Street 2:SUITE 235
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-5609
Mailing Address - Country:US
Mailing Address - Phone:210-225-1916
Mailing Address - Fax:210-212-9055
Practice Address - Street 1:1303 MCCULLOUGH AVE
Practice Address - Street 2:SUITE 235
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5609
Practice Address - Country:US
Practice Address - Phone:210-225-1916
Practice Address - Fax:210-212-9055
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7221208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097484201Medicaid
TX097484201Medicaid
TX741903735OtherTAX ID NUMBER
TXC20035Medicare UPIN