Provider Demographics
NPI:1902124779
Name:BOYLE, MARK RODGER
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:RODGER
Last Name:BOYLE
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 1:1ST MSOB, LOS FLORES
Mailing Address - Street 2:BOX 555341
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:92055-5341
Mailing Address - Country:US
Mailing Address - Phone:760-725-5250
Mailing Address - Fax:
Practice Address - Street 1:1ST MSOB, LOS FLORES
Practice Address - Street 2:555341
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:92055-5341
Practice Address - Country:US
Practice Address - Phone:760-725-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman