Provider Demographics
NPI:1326056557
Name:BOYD, CLARENCE A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:A
Last Name:BOYD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:13847 E 14TH ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2632
Mailing Address - Country:US
Mailing Address - Phone:510-483-3191
Mailing Address - Fax:
Practice Address - Street 1:13847 E 14TH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2632
Practice Address - Country:US
Practice Address - Phone:510-483-3191
Practice Address - Fax:510-483-3436
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2017-05-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG-36912207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G369120Medicaid
CAA46861Medicare UPIN
CA00G369120Medicare PIN