Healthcare Provider Details

I. General information

NPI: 1801839964
Provider Name (Legal Business Name): WILLIAM AARON BROYLES D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 CHESTNUT ST
MARS HILL NC
28754-9602
US

IV. Provider business mailing address

105 CHESTNUT ST
MARS HILL NC
28754-9602
US

V. Phone/Fax

Practice location:
  • Phone: 828-680-1161
  • Fax: 828-680-1191
Mailing address:
  • Phone: 828-680-1161
  • Fax: 828-680-1191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC 004687L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25 MD00278700
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number580
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: