Provider Demographics
NPI:1417944786
Name:BOYCE, BRENT M (MD)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:M
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 1:106 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SEBEWAING
Mailing Address - State:MI
Mailing Address - Zip Code:48759-1568
Mailing Address - Country:US
Mailing Address - Phone:989-883-3800
Mailing Address - Fax:989-883-9131
Practice Address - Street 1:106 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SEBEWAING
Practice Address - State:MI
Practice Address - Zip Code:48759-1568
Practice Address - Country:US
Practice Address - Phone:989-883-3800
Practice Address - Fax:989-883-9131
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074469207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
200060755OtherCOMMERCIAL
H97181Medicare UPIN
MI0N79960Medicare PIN