Provider Demographics
NPI:1235102948
Name:BOYD, EDGAR MORRIS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:MORRIS
Last Name:BOYD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EDGAR
Other - Middle Name:M
Other - Last Name:BOYD
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1805 N YORK ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-1404
Mailing Address - Country:US
Mailing Address - Phone:918-682-4580
Mailing Address - Fax:918-681-4566
Practice Address - Street 1:1805 N YORK ST
Practice Address - Street 2:SUITE F
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-1404
Practice Address - Country:US
Practice Address - Phone:918-682-4580
Practice Address - Fax:918-681-4566
Is Sole Proprietor?:No
Enumeration Date:2006-02-12
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18352207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100848310AMedicaid
OK100848310AMedicaid