Provider Demographics
NPI:1831184365
Name:BOYETTE, DEANNA M (MD)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:M
Last Name:BOYETTE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2573 STANTONSBURG RD STE B
Mailing Address - Street 2:BOYETTE ORTHOPEDICS & SPORTS MEDICINE PA
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7613
Mailing Address - Country:US
Mailing Address - Phone:252-215-5200
Mailing Address - Fax:252-215-0213
Practice Address - Street 1:2573 STANTONSBURG RD STE B
Practice Address - Street 2:BOYETTE ORTHOPEDICS & SPORTS MEDICINE PA
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7613
Practice Address - Country:US
Practice Address - Phone:252-215-5200
Practice Address - Fax:252-215-0213
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2011-03-31
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Provider Licenses
StateLicense IDTaxonomies
NC9400729207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8917322Medicaid
NC2202833CMedicare PIN
NC2202833DMedicare PIN
NC8917322Medicaid