Provider Demographics
NPI:1063642858
Name:BOYCE, MARY FOWLER (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:FOWLER
Last Name:BOYCE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 100237
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0237
Mailing Address - Country:US
Mailing Address - Phone:352-273-5159
Mailing Address - Fax:352-273-5213
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-273-5159
Practice Address - Fax:352-273-5213
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2015-12-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME123786207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015690900Medicaid
FLIH889ZMedicare PIN
FL015690900Medicaid