MEDICARE: DORRUTH BOYD FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	513575	TX

General Provider Information

NPI Number	:	1255628665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORRUTH BOYD FNP-BC

Provider Business Mailing Address
First Line	:	5135 MENEFEE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75227-1432
Country	:	US
Telephone Number	:	214-275-2062
Fax Number	:	214-381-9064

Provider Business Practice Location Address
First Line	:	5135 MENEFEE DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75227-1432
Country	:	US
Telephone Number	:	214-275-2062
Fax Number	:	214-381-9064

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2011
Last Update Date	:	07/06/2011

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Directions to “ DORRUTH BOYD FNP-BC” Practice Location

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