Provider Demographics
NPI:1801985833
Name:BOYER, HOLLY M (MD)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:M
Last Name:BOYER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:573-499-9009
Mailing Address - Fax:573-499-4400
Practice Address - Street 1:900 W NIFONG STE 101
Practice Address - Street 2:STE 104
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203
Practice Address - Country:US
Practice Address - Phone:573-499-9009
Practice Address - Fax:573-499-4400
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2016-01-26
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Provider Licenses
StateLicense IDTaxonomies
MO115336207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205416001Medicaid
MO470930OtherHEALTHLINK
MOH42926Medicare UPIN
MO962221444Medicare PIN
MOP00415512Medicare PIN
MO470930OtherHEALTHLINK
MO205416001Medicaid