Provider Demographics
NPI:1083697114
Name:BOYD, JEFFREY HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:HOWARD
Last Name:BOYD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:57 BETHANY WOODS RD
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:CT
Mailing Address - Zip Code:06524-3103
Mailing Address - Country:US
Mailing Address - Phone:203-573-8555
Mailing Address - Fax:203-597-9565
Practice Address - Street 1:969 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2653
Practice Address - Country:US
Practice Address - Phone:203-573-8555
Practice Address - Fax:203-597-9565
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0194702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC65024Medicare UPIN