G P Boyum MD PLLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

21557 Issued in MN

Legal business name

G P BOYUM MD PLLC

Practice address

2275 Overlook CT N
Stillwater, MN 55082-1566

Phone

(651) 439-6845

NPI assigned

Mar 17, 2015

Last updated

Mar 17, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

George Peter Boyum, MD

Title

Owner

Phone

(651) 439-6845

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1426550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426550400000",
    "number": "1801289640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2275 OVERLOOK CT N",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550821566",
            "telephone_number": "651-439-6845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2275 OVERLOOK CT N",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550821566",
            "telephone_number": "651-439-6845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "G P BOYUM MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-17",
        "last_updated": "2015-03-17",
        "status": "A",
        "authorized_official_last_name": "BOYUM",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "PETER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-439-6845",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MN",
            "license": "21557",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allison Paulette Freeman
• Mary G Freitag, PSYD LP
• Melissa Hanner Frisvold, CNM
• Lisa Marie Fritz, P.A.
• Brieana Jane Fuller
• Alison Gardner, PA-C
• Karen Garley, CPM
• Sara Marie Garner, DPT
• Mark E George, MD
• Kathleen Geraghty, CCC-SLP

• Clinic/Center in Stillwater, MN
• Providers in Stillwater, MN by specialty
• Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.