Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 23945 | WV |
NPI | 1033396536 |
---|---|
Provider Name | Dr. Jill A Boyce |
First Address | Beaver, WV 25813 |
Second Address | Beaver, WV 25813-8977 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2008 |
Last Update Date | 15/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810018447 | (05) | WV |