Healthcare Provider Details

I. General information

NPI: 1629183702
Provider Name (Legal Business Name): JOHN L BOYD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 S 31ST ST
TEMPLE TX
76508-0001
US

IV. Provider business mailing address

2401 S 31ST ST
TEMPLE TX
76508-0001
US

V. Phone/Fax

Practice location:
  • Phone: 254-724-7232
  • Fax: 254-724-7646
Mailing address:
  • Phone: 254-724-7232
  • Fax: 254-724-7646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH9303
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: