Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 01060396A | IN |
Y | 208600000X | Surgeon | 01060396A | IN |
NPI | 1003113978 |
---|---|
Provider Name | Vincent Craig Boyd |
First Address | Washington, IN 47501-2860 |
Second Address | Washington, IN 47501-2860 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2011 |
Last Update Date | 11/02/2011 |