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NPI Code Detail

MEDICARE: DR. DANIEL STREET BOYD M.D.

MEDICARE: DR. DANIEL STREET BOYD M.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
12084P0800XPsychiatry PhysicianMD021833TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10191922OTHERTNBLUE CROSS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MD021833OTHERTNMEDICAL LICENSE

General Provider Information

NPI Number : 1891798989
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DANIEL STREET BOYD M.D.
Provider Business Mailing Address
First Line : PO BOX 381693
Second Line :
City : GERMANTOWN
State : TN
Zip : 38183-1693
Country : US
Telephone Number : 901-405-6460
Fax Number : 901-747-2338
Provider Business Practice Location Address
First Line : 2911 BRUNSWICK RD
Second Line :
City : MEMPHIS
State : TN
Zip : 38133-4105
Country : US
Telephone Number : 901-377-4700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 01/21/2008

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