Provider Demographics
NPI:1457385692
Name:BOYER, MICHAEL JAMES
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:BOYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9951 MICKELBERRY RD NW
Mailing Address - Street 2:STE 101
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8309
Mailing Address - Country:US
Mailing Address - Phone:360-692-9362
Mailing Address - Fax:360-692-6214
Practice Address - Street 1:9951 MICKELBERRY RD NW
Practice Address - Street 2:KITSAP CHILDRENS CLINIC LLP
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8309
Practice Address - Country:US
Practice Address - Phone:360-692-9362
Practice Address - Fax:360-692-6214
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00014861208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1184506Medicaid
WAMD00014861OtherMD LICENSE
WAMD00014861OtherMD LICENSE
E27590Medicare UPIN
WA1184506Medicaid