Individual
MR. JERRY EDWIN BOYER
Active
Individual
MR. JERRY EDWIN BOYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
PS002678L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03106101
CBC PRACTITIONER ID
PA
01
—
338947
VALUE OPTIONS
PA
Enumeration date
02/21/2007
Last updated
07/08/2007
Update your record
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