Provider Demographics
NPI:1154442986
Name:BOYD, CHRISTABETH GUPANA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTABETH
Middle Name:GUPANA
Last Name:BOYD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTABETH
Other - Middle Name:J R
Other - Last Name:GUPANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1235 SE DIVISION ST
Mailing Address - Street 2:STE 115
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1085
Mailing Address - Country:US
Mailing Address - Phone:541-754-1150
Mailing Address - Fax:
Practice Address - Street 1:1235 SE DIVISION ST
Practice Address - Street 2:STE 115
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1085
Practice Address - Country:US
Practice Address - Phone:541-754-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98049207Q00000X
ORMD158688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1033357736Medicaid
CAZZZ55168YOtherBS/TRIWEST
CA1831365667Medicaid
CA1154442986Medicaid
CA1831365667Medicaid
CA1033357736Medicaid