Healthcare Provider Details

I. General information

NPI: 1023194636
Provider Name (Legal Business Name): JEFFREY STEPHEN BOYD PA - C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 S CENTRAL AVE P. O. DRAWER 2325
UMATILLA FL
32784-9602
US

IV. Provider business mailing address

390 S CENTRAL AVE P. O. DRAWER 2325
UMATILLA FL
32784-9602
US

V. Phone/Fax

Practice location:
  • Phone: 352-669-3175
  • Fax: 352-669-3640
Mailing address:
  • Phone: 352-669-3175
  • Fax: 352-669-3640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9101362
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: