MEDICARE: MR. BRIAN J. W. 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
1	2084N0400X	Neurology Physician	G59654	CA
2	208VP0000X	Pain Medicine Physician	G59654	CA

General Provider Information

NPI Number	:	1932242302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN J. W. BOYD M.D.

Provider Business Mailing Address
First Line	:	1140 WEST LA VETA
Second Line	:	STE 410
City	:	ORANGE
State	:	CA
Zip	:	92868-4226
Country	:	US
Telephone Number	:	714-285-0615
Fax Number	:	714-285-0619

Provider Business Practice Location Address
First Line	:	1140 WEST LA VETA
Second Line	:	STE 410
City	:	ORANGE
State	:	CA
Zip	:	92868-4226
Country	:	US
Telephone Number	:	714-285-0615
Fax Number	:	714-285-0619

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	03/14/2011

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