Healthcare Provider Details

I. General information

NPI: 1154494425
Provider Name (Legal Business Name): GEORGE BORLAND BOYD III DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7838 BARLITE BLVD
SAN ANTONIO TX
78224-1364
US

IV. Provider business mailing address

7838 BARLITE BLVD
SAN ANTONIO TX
78224-1364
US

V. Phone/Fax

Practice location:
  • Phone: 210-932-9729
  • Fax: 210-855-0522
Mailing address:
  • Phone: 210-932-9729
  • Fax: 210-855-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberM9876
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberM9876
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberM9876
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: