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Individual
DR. THEL G BOYETTE
Active
Individual
DR. THEL G BOYETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
127611
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00026002801
UNIVERA#
NY
05
—
00363020
—
NY
05
—
00372225
—
NY
01
—
2222
BLUE SHIELD GROUP #
NY
01
—
5399024
GHI #
NY
01
—
5763326
AETNA PROVIDER#
NY
01
—
G0189393590
BLUE CHOICE GROUP #
NY
01
—
MDC629
PREFERRED CARE #
NY
Enumeration date
07/14/2006
Last updated
07/09/2007
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