Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 34393 | IA |
NPI | 1316039670 |
---|---|
Provider Name | Dr. Bern Rex Boyett |
First Address | Des Moines, IA 50316-2350 |
Second Address | Des Moines, IA 50316-2350 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 08/07/2007 |