Provider Demographics
NPI:1003820531
Name:BOYLES, RICHARD (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:BOYLES
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 1:86 WREN ST
Mailing Address - Street 2:
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-1529
Mailing Address - Country:US
Mailing Address - Phone:803-259-5762
Mailing Address - Fax:803-259-3250
Practice Address - Street 1:130 BAKER ST N
Practice Address - Street 2:
Practice Address - City:BLACKVILLE
Practice Address - State:SC
Practice Address - Zip Code:29817-2426
Practice Address - Country:US
Practice Address - Phone:803-284-1045
Practice Address - Fax:803-284-3094
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12925207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC12925OtherMEDICAL LICENSE
SCB92027OtherMEDICARE
SC129257Medicaid