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General NPI Number Information
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NPI Number | 1578736856
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Entity Type | Organization
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Legal Business Name | BRUCE BOYD
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 10/08/2010
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Provider Practice Location Address
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Address Line | 211 ALCORN DR
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City | CORINTH
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State | MS
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Zip | 38834-8400
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Country | US
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Telephone | 662-286-2700
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Fax | 662-286-2773
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Provider Business Mailing Address
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Address Line | 211 ALCORN DR
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City | CORINTH
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State | MS
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Zip | 38834-8400
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Country | US
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Telephone | 662-286-2700
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Fax | 662-286-2773
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Authorized Official
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Title or Position | DR.
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Name | BRUCE K. BOYD
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Credential | D.P.M.
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Telephone | 662-286-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 80100
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License Number State | MS
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