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General NPI Number Information
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NPI Number | 1265619787
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Entity Type | Organization
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Legal Business Name | BOVARD BARIATRIC CENTER PA
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Dates
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Enumeration Date | 01/28/2008
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | 11200 GOVERNOR MANLY WAY SUITE 200
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City | RALEIGH
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State | NC
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Zip | 27614-8599
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Country | US
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Telephone | 919-340-2263
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Fax | 919-554-3771
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Provider Business Mailing Address
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Address Line | 11200 GOVERNOR MANLY WAY SUITE 200
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City | RALEIGH
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State | NC
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Zip | 27614-8599
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Country | US
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Telephone | 919-340-2263
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Fax | 919-554-3771
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Authorized Official
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Title or Position | OWNER
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Name | SCOTT BOVARD
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Credential | MD
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Telephone | 919-340-2263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2008-00006
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License Number State | NC
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