Provider Demographics
NPI:1841296696
Name:BOYLE, JEFFREY G (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:G
Last Name:BOYLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190930
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-0930
Mailing Address - Country:US
Mailing Address - Phone:082-367-5170
Mailing Address - Fax:082-367-5180
Practice Address - Street 1:4424 E FLAMINGO AVE STE 220
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-9291
Practice Address - Country:US
Practice Address - Phone:208-302-1100
Practice Address - Fax:208-302-1155
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5300207VM0101X
IDM-17456207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14610Medicaid
SD6201000Medicaid
SDS41693Medicare PIN
SD6201000Medicaid
ND14610Medicaid