Provider Demographics
NPI:1023194636
Name:BOYD, JEFFREY STEPHEN (PA - C)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:STEPHEN
Last Name:BOYD
Suffix:
Gender:M
Credentials:PA - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:390 S CENTRAL AVE
Mailing Address - Street 2:P. O. DRAWER 2325
Mailing Address - City:UMATILLA
Mailing Address - State:FL
Mailing Address - Zip Code:32784-9602
Mailing Address - Country:US
Mailing Address - Phone:352-669-3175
Mailing Address - Fax:352-669-3640
Practice Address - Street 1:390 S CENTRAL AVE
Practice Address - Street 2:P. O. DRAWER 2325
Practice Address - City:UMATILLA
Practice Address - State:FL
Practice Address - Zip Code:32784-9602
Practice Address - Country:US
Practice Address - Phone:352-669-3175
Practice Address - Fax:352-669-3640
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9101362363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant