Provider Demographics
NPI:1538157334
Name:BOATWRIGHT, STEPHEN E (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:E
Last Name:BOATWRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3926 WESLEY ST
Mailing Address - Street 2:SUITE 502
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-7332
Mailing Address - Country:US
Mailing Address - Phone:843-353-1596
Mailing Address - Fax:843-236-5088
Practice Address - Street 1:4736 HIGHWAY 17 BYP S
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-5616
Practice Address - Country:US
Practice Address - Phone:843-231-2039
Practice Address - Fax:843-293-2454
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12340207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC123404Medicaid
SC123404Medicaid
B92054Medicare UPIN