Healthcare Provider Details

I. General information

NPI: 1083167118
Provider Name (Legal Business Name): MADELINE BOYD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 DAGGETT AVE STE 100
KLAMATH FALLS OR
97601-1130
US

IV. Provider business mailing address

PO BOX 2120
PORTLAND OR
97208-2120
US

V. Phone/Fax

Practice location:
  • Phone: 541-274-6733
  • Fax: 541-274-2006
Mailing address:
  • Phone: 541-274-6733
  • Fax: 541-274-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD200646
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0000
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberMD200646
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: