Provider Demographics
NPI:1942205604
Name:BOYAJIAN, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BOYAJIAN
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 1:3085 E MAGIC VIEW DR # 140
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-3757
Mailing Address - Country:US
Mailing Address - Phone:208-433-9300
Mailing Address - Fax:208-433-9854
Practice Address - Street 1:3085 E MAGIC VIEW DR # 140
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-3757
Practice Address - Country:US
Practice Address - Phone:208-433-9300
Practice Address - Fax:208-433-9854
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM6896207YX0602X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003581300Medicaid
ID003581300Medicaid
ID1133833Medicare ID - Type Unspecified