Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 0101242828 | VA |
N | 111NI0900X | Internist | 0101242828 | VA |
Y | 207R00000X | Internist | 2011-00137 | NC |
Y | 111NI0900X | Internist | 2011-00137 | NC |
N | 207RG0300X | Geriatric Medicine | 0101242828 | VA |
N | 207RG0300X | Geriatric Medicine | 2011-00137 | NC |
NPI | 1053525501 |
---|---|
Provider Name | Lillian Kizer Boyd |
First Address | Charlotte, NC 28275-1069 |
Second Address | Greenville, NC 27834-2849 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 15/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1619J | BCBSNC (01) | NC |
5916975 | (05) | NC |