Provider Demographics
NPI:1881893725
Name:BOYTIM, EDWARD COLLIER (CRNA, CNS)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:COLLIER
Last Name:BOYTIM
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Gender:M
Credentials:CRNA, CNS
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Mailing Address - Street 1:1737 BRIARCREST DR
Mailing Address - Street 2:SUITE 14
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2769
Mailing Address - Country:US
Mailing Address - Phone:979-776-4777
Mailing Address - Fax:
Practice Address - Street 1:1737 BRIARCREST DR
Practice Address - Street 2:SUITE 14
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2769
Practice Address - Country:US
Practice Address - Phone:979-776-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2017-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX681543367500000X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2181752-04Medicaid
TXTXB157096Medicare PIN