Provider Demographics
NPI:1407959760
Name:BOICE, BRETT EUGENE (D O)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:EUGENE
Last Name:BOICE
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 NW 1ST LANE
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:MO
Mailing Address - Zip Code:64759-8105
Mailing Address - Country:US
Mailing Address - Phone:417-681-5266
Mailing Address - Fax:417-681-5526
Practice Address - Street 1:29 NW 1ST LANE
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:MO
Practice Address - Zip Code:64759-8105
Practice Address - Country:US
Practice Address - Phone:417-681-5266
Practice Address - Fax:417-681-5526
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105928207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO268648OtherRHC PTAN
MO247646003Medicaid
MO268625OtherRHC PTAN
E69067Medicare UPIN
MO247646003Medicaid