Provider Demographics
NPI:1114908688
Name:BOYD, SUSAN WEBB (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:WEBB
Last Name:BOYD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 S RYAN ST
Mailing Address - Street 2:#103
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5724
Mailing Address - Country:US
Mailing Address - Phone:337-439-0555
Mailing Address - Fax:337-436-6223
Practice Address - Street 1:555 S RYAN ST
Practice Address - Street 2:#103
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5724
Practice Address - Country:US
Practice Address - Phone:337-439-0555
Practice Address - Fax:337-436-6223
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL019179207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1388955Medicaid
E25181Medicare UPIN
5H930Medicare ID - Type Unspecified