MEDICARE: DR. DOUGLAS DEWITT BOYETTE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	28139	NC

General Provider Information

NPI Number	:	1164562583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS DEWITT BOYETTE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 7933
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-0933
Country	:	US
Telephone Number	:	252-937-7889
Fax Number	:	252-451-3439

Provider Business Practice Location Address
First Line	:	157 CANDLEWOOD RD
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-2105
Country	:	US
Telephone Number	:	252-937-7889
Fax Number	:	252-451-3439

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	01/08/2008

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