Healthcare Provider Details

I. General information

NPI: 1962446989
Provider Name (Legal Business Name): ALLEN D BOYD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 S WILLARD ST SUITE 105
COTTONWOOD AZ
86326-6743
US

IV. Provider business mailing address

1200 N BEAVER ST PAYER CREDENTIALING
FLAGSTAFF AZ
86001-3118
US

V. Phone/Fax

Practice location:
  • Phone: 928-634-1112
  • Fax: 928-634-1117
Mailing address:
  • Phone: 928-773-2559
  • Fax: 928-213-6292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number191229
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number50006
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: