Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 12925 | SC |
NPI | 1003820531 |
---|---|
Provider Name | Richard Boyles |
First Address | Barnwell, SC 29812-1529 |
Second Address | Blackville, SC 29817-2426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 29/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12925 | MEDICAL LICENSE (01) | SC |
129257 | (05) | SC |
B92027 | MEDICARE (01) | SC |