Basic Information
| Provider Information | |||||||||
| NPI: | 1699703553 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOYER | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | HARRISON | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2415 N ORANGE AVE STE 700 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328045521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073032474 | ||||||||
| FaxNumber: | 4073030680 | ||||||||
| Practice Location | |||||||||
| Address1: | 2415 N ORANGE AVE STE 700 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328045521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073032474 | ||||||||
| FaxNumber: | 4073030680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 08/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | ME62668 | FL | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 371267200 | 05 | FL | MEDICAID |