Provider Demographics
NPI:1164562583
Name:BOYETTE, DOUGLAS DEWITT (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:DEWITT
Last Name:BOYETTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7933
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0933
Mailing Address - Country:US
Mailing Address - Phone:252-937-7889
Mailing Address - Fax:252-451-3439
Practice Address - Street 1:157 CANDLEWOOD RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2105
Practice Address - Country:US
Practice Address - Phone:252-937-7889
Practice Address - Fax:252-451-3439
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC28139207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC204945BMedicare PIN
NCC82916Medicare UPIN