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NPI Code Detail

MEDICARE: DR. JOSEPH C BOALS IV M.D.

MEDICARE: DR. JOSEPH C BOALS IV 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
1208000000XPediatrics Physician72688NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306811856
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSEPH C BOALS IV M.D.
Provider Business Mailing Address
First Line : 195 W ILLINOIS AVE
Second Line :
City : SOUTHERN PINES
State : NC
Zip : 28387-5808
Country : US
Telephone Number : 910-692-2444
Fax Number : 910-692-3651
Provider Business Practice Location Address
First Line : 195 W ILLINOIS AVE
Second Line :
City : SOUTHERN PINES
State : NC
Zip : 28387-5808
Country : US
Telephone Number : 910-692-2444
Fax Number : 910-692-3651
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2006
Last Update Date : 05/22/2008

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