Provider Demographics
NPI:1093822553
Name:BOYCE, STEPHEN GLENN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:GLENN
Last Name:BOYCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10810 PARKSIDE DR STE 305
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1986
Mailing Address - Country:US
Mailing Address - Phone:865-392-3971
Mailing Address - Fax:865-392-3972
Practice Address - Street 1:10810 PARKSIDE DR STE 305
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1986
Practice Address - Country:US
Practice Address - Phone:865-392-3971
Practice Address - Fax:865-392-3972
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 22153208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ002850Medicaid
3066216Medicare PIN
E02285Medicare UPIN