Healthcare Provider Details

I. General information

NPI: 1730257924
Provider Name (Legal Business Name): EMILY BETH BOYD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 VETERANS MEMORIAL DR
MOUNT VERNON IL
62864-5951
US

IV. Provider business mailing address

3408 OFFICE PARK DR
MARION IL
62959-6477
US

V. Phone/Fax

Practice location:
  • Phone: 618-997-5266
  • Fax: 618-997-5285
Mailing address:
  • Phone: 618-997-5266
  • Fax: 618-997-5285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number207V00000X
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: