Provider Demographics
NPI:1497712780
Name:BOYD, LINDA RENEE (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:RENEE
Last Name:BOYD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3667 PARK OVERLOOK DR
Mailing Address - Street 2:UNIT #114
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-7407
Mailing Address - Country:US
Mailing Address - Phone:719-930-1260
Mailing Address - Fax:
Practice Address - Street 1:2510 FIFTH STREET, AREA B, BLDG 840
Practice Address - Street 2:
Practice Address - City:WRIGHT PATTERSON AIR FORCE BASE
Practice Address - State:OH
Practice Address - Zip Code:45433
Practice Address - Country:US
Practice Address - Phone:937-938-3086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43697207PE0004X
TXM5070207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVBF374ZMedicare PIN