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General NPI Number Information
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NPI Number | 1144628447
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Entity Type | Organization
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Legal Business Name | PINE TREES MEDICAL OFFICE, P.C.
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Dates
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Enumeration Date | 12/18/2014
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Last Update Date | 12/18/2014
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Provider Practice Location Address
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Address Line | 604 W MAIN ST STE B
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City | GAYLORD
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State | MI
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Zip | 49735-1869
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Country | US
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Telephone | 989-448-2900
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Fax |
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Provider Business Mailing Address
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Address Line | 604 W MAIN ST STE B
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City | GAYLORD
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State | MI
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Zip | 49735-1869
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Country | US
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Telephone | 989-448-2900
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | ROY W BOYER
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Credential | M.D.
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Telephone | 989-448-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301028315
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License Number State | MI
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