MEDICARE: EDGAR M. BOYD, JR. M.D. PC

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	207Y00000X	Otolaryngology Physician	18352	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	7214386	OTHER	OK	AETNA

General Provider Information

NPI Number	:	1992950059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDGAR M. BOYD, JR. M.D. PC

Provider Business Mailing Address
First Line	:	101 ROCKEFELLER DR
Second Line	:	STE 203
City	:	MUSKOGEE
State	:	OK
Zip	:	74401
Country	:	US
Telephone Number	:	918-682-4580
Fax Number	:	918-681-4566

Provider Business Practice Location Address
First Line	:	101 ROCKEFELLER DR STE 203
Second Line	:
City	:	MUSKOGEE
State	:	OK
Zip	:	74401-5050
Country	:	US
Telephone Number	:	918-682-4580
Fax Number	:	918-681-4566

Authorized Official
Title or Position	:	PHYSCIAN
Name	:	DR. EDGAR MORRIS BOYD JR.
Credential	:	M.D.
Telephone Number	:	918-682-4580

Provider Enumeration Date	:	11/17/2008
Last Update Date	:	11/17/2008

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