Provider Demographics
NPI:1043794514
Name:BOYD, ZACHARY KEITH
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:KEITH
Last Name:BOYD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 N CHEYENNE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-4134
Mailing Address - Country:US
Mailing Address - Phone:918-951-2878
Mailing Address - Fax:
Practice Address - Street 1:1622 N CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-4134
Practice Address - Country:US
Practice Address - Phone:918-951-2878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator