Provider Demographics
NPI:1528005576
Name:BOYD, RICHARD FREDERICK (RN, CRNA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:FREDERICK
Last Name:BOYD
Suffix:
Gender:M
Credentials:RN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 EPPS ST
Mailing Address - Street 2:
Mailing Address - City:PEAKS ISLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04108-1206
Mailing Address - Country:US
Mailing Address - Phone:207-766-3050
Mailing Address - Fax:207-766-3050
Practice Address - Street 1:15 EPPS ST
Practice Address - Street 2:
Practice Address - City:PEAKS ISLAND
Practice Address - State:ME
Practice Address - Zip Code:04108-1206
Practice Address - Country:US
Practice Address - Phone:207-766-3050
Practice Address - Fax:207-766-3050
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER018347367500000X
SDCR000611367500000X
NE100853367500000X
VA0024167006367500000X
TXR018347367500000X
MEAA083210367500000X
NH058929-23367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44344000Medicaid