Provider Demographics
NPI:1982840815
Name:VALLEY PEDIATRIC CARDIOLOGY, P.L.L.C
Entity Type:Organization
Organization Name:VALLEY PEDIATRIC CARDIOLOGY, P.L.L.C
Other - Org Name:CLARK A. BOYER, MD.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:ABILIO
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-464-8600
Mailing Address - Street 1:702 E. EXPRESSWAY 83 SUITE A3
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537
Mailing Address - Country:US
Mailing Address - Phone:956-464-8600
Mailing Address - Fax:956-464-8601
Practice Address - Street 1:702 E. EXPRESSWAY 83 SUITE A3
Practice Address - Street 2:
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537
Practice Address - Country:US
Practice Address - Phone:956-464-8600
Practice Address - Fax:956-464-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-24
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM00192080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM0019OtherLICENSE