Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 80100 | MS |
N | 213EP1101X | Primary Podiatric Medicine | DPM0000000341 | TN |
NPI | 1386715514 |
---|---|
Provider Name | Dr. Bruce K. Boyd |
First Address | Corinth, MS 38834-8400 |
Second Address | Corinth, MS 38834-8400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 23/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00110447 | (05) | MS |
2005806 | BCBS OF TN (01) | TN |
7917 | TLC (01) | |
T82067 | (02) | MS |
T82067 | (02) | TN |
UNITED HEALTHCARE | 2700155 (01) | TN |