Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | MD.205264 | LA |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | E-7894 | AR |
NPI | 1922216084 |
---|---|
Provider Name | Dr. Jennings R Boyette |
First Address | Little Rock, AR 72205-3937 |
Second Address | Little Rock, AR 72205-7101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2007 |
Last Update Date | 03/07/2013 |