Provider Demographics
NPI:1073582847
Name:BOYD, JOHN C (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:BOYD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W 5TH AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2715
Mailing Address - Country:US
Mailing Address - Phone:509-344-2663
Mailing Address - Fax:509-624-9179
Practice Address - Street 1:601 W 5TH AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2715
Practice Address - Country:US
Practice Address - Phone:509-344-2663
Practice Address - Fax:509-624-9179
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10001691363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7367OtherGROUP HEALTH NW
WA8931641OtherCRIME VICTIMS
WA8374761Medicaid
ID000010149520OtherREGENCE BLUE SHIELD OF ID
WA180730OtherDEPT OF LABOR & INDUSTRIE
WA2595BOOtherASURIS NW HEALTH
IDKQ563OtherBLUE CROSS OF IDAHO
IDKQ563OtherBLUE CROSS OF IDAHO
WA8931641OtherCRIME VICTIMS