Provider Demographics
NPI:1497921134
Name:BOYD, JESSAMY ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSAMY
Middle Name:ANNE
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:8196 WALNUT HILL LN STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-7001
Practice Address - Country:US
Practice Address - Phone:214-739-4175
Practice Address - Fax:214-987-4161
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1354972085R0001X
TXN06572085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199319803Medicaid
TXP01582148OtherRAILROAD MADICARE
TX199319804Medicaid
TX314735YKYCMedicare PIN
TXP01582148OtherRAILROAD MADICARE