Provider Demographics
NPI:1477663599
Name:BOYD, DON ALLEN (EDD)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:ALLEN
Last Name:BOYD
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 BURTON ST SE STE B
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-4398
Mailing Address - Country:US
Mailing Address - Phone:616-957-3279
Mailing Address - Fax:616-957-0493
Practice Address - Street 1:3300 BURTON ST SE STE B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-4398
Practice Address - Country:US
Practice Address - Phone:616-957-3279
Practice Address - Fax:616-957-0493
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002544103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D130050OtherBLUE CROSS
MI0D130050OtherBLUE CROSS
MIR67263Medicare UPIN