Healthcare Provider Details

I. General information

NPI: 1962441808
Provider Name (Legal Business Name): KER BOYCE IV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 01/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 PAGE RD
PINEHURST NC
28374-8798
US

IV. Provider business mailing address

205 PAGE RD
PINEHURST NC
28374-8798
US

V. Phone/Fax

Practice location:
  • Phone: 910-295-5511
  • Fax: 910-235-3422
Mailing address:
  • Phone: 910-295-5511
  • Fax: 910-235-3422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number9900776
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number9900776
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: