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General NPI Number Information
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NPI Number | 1235238239
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Entity Type | Individual
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Provider Name | BRANDON MARK BOYCE MD
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 06/19/2013
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Provider Practice Location Address
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Address Line | 612 W GORDON ST SUITE E
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City | THOMASTON
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State | GA
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Zip | 30286-3480
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Country | US
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Telephone | 706-647-3030
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Fax | 706-647-3033
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Provider Business Mailing Address
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Address Line | 612 W GORDON ST SUITE E
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City | THOMASTON
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State | GA
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Zip | 30286-3480
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Country | US
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Telephone | 706-647-3030
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Fax | 706-647-3033
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 50370
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License Number State | CO
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