Provider Demographics
NPI:1417032699
Name:BOYD, JOSEPH BARRY (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BARRY
Last Name:BOYD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BENMORE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4101
Mailing Address - Country:US
Mailing Address - Phone:407-645-2007
Mailing Address - Fax:407-645-4671
Practice Address - Street 1:200 BENMORE DR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4101
Practice Address - Country:US
Practice Address - Phone:407-645-2007
Practice Address - Fax:407-645-4671
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41419208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D62528Medicare UPIN