=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225075849
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | R. DEVEE BOYD M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 N. EAST STREET
-----------------------------------------------------
City | JOSEPH
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97846
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-432-7777
-----------------------------------------------------
Fax | 541-432-7170
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1038 100 N. EAST STREET
-----------------------------------------------------
City | JOSEPH
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97846-1038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-432-7777
-----------------------------------------------------
Fax | 541-432-7170
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD16299
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------