Healthcare Provider Details

I. General information

NPI: 1336153808
Provider Name (Legal Business Name): WHITSON HINES BOYD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1549 S JEFFERSON ST
MONTICELLO FL
32344-1651
US

IV. Provider business mailing address

1549 S JEFFERSON ST
MONTICELLO FL
32344-1651
US

V. Phone/Fax

Practice location:
  • Phone: 850-997-0707
  • Fax: 850-997-6833
Mailing address:
  • Phone: 850-997-0707
  • Fax: 850-997-6833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9102923
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: