Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 04783 | SC |
NPI | 1194704726 |
---|---|
Provider Name | William Clarence Boggs |
First Address | Columbia, SC 29208-0001 |
Second Address | Columbia, SC 29208-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D99141 | (02) |