Healthcare Provider Details

I. General information

NPI: 1578505319
Provider Name (Legal Business Name): JAMES WILSON BOYD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 S HURSTBOURNE PKWY STE 210
LOUISVILLE KY
40222-5757
US

IV. Provider business mailing address

1230 S HURSTBOURNE PKWY STE 210
LOUISVILLE KY
40222-5757
US

V. Phone/Fax

Practice location:
  • Phone: 502-583-2731
  • Fax:
Mailing address:
  • Phone: 502-583-2731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number10940
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number15098
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number51344
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number51344
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: