Provider Demographics
NPI:1376117762
Name:BOYD, BRANDON TAYLOR JACOBS (DO)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:TAYLOR JACOBS
Last Name:BOYD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 N COLUMBUS ST STE 260
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8100
Mailing Address - Country:US
Mailing Address - Phone:740-687-8397
Mailing Address - Fax:740-654-4103
Practice Address - Street 1:2405 N COLUMBUS ST STE 260
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8100
Practice Address - Country:US
Practice Address - Phone:740-687-8397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program