MEDICARE: DR. JOHN STERLING BOYDEN JR. M.D. J.D.

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	209800000X	Legal Medicine (M.D./D.O.) Physician	151081-1205	UT

General Provider Information

NPI Number	:	1548568249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN STERLING BOYDEN JR. M.D. J.D.

Provider Business Mailing Address
First Line	:	1942 YALECREST AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1844
Country	:	US
Telephone Number	:	801-582-1942
Fax Number	:

Provider Business Practice Location Address
First Line	:	1942 YALECREST AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1844
Country	:	US
Telephone Number	:	801-582-1942
Fax Number	:

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

Provider Enumeration Date	:	03/03/2011
Last Update Date	:	03/03/2011

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