Healthcare Provider Details

I. General information

NPI: 1487664900
Provider Name (Legal Business Name): JOHN THOMAS BOYD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 REID ST FT LEWIS MAMC
TACOMA WA
98431-1100
US

IV. Provider business mailing address

2037 MINOR AVE E
SEATTLE WA
98102-3513
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-3066
  • Fax:
Mailing address:
  • Phone: 206-860-9321
  • Fax: 253-968-5573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number00018810
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: