Provider Demographics
NPI:1558523118
Name:BOYD, TIFFINY M (DO)
Entity Type:Individual
Prefix:
First Name:TIFFINY
Middle Name:M
Last Name:BOYD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TIFFINY
Other - Middle Name:M
Other - Last Name:GRACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3196 S MARYLAND PKWY STE 208
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2313
Mailing Address - Country:US
Mailing Address - Phone:702-796-1820
Mailing Address - Fax:702-796-3938
Practice Address - Street 1:3196 S MARYLAND PKWY STE 208
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2313
Practice Address - Country:US
Practice Address - Phone:702-796-1820
Practice Address - Fax:702-796-3938
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO1607208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1558523118Medicaid
NVV107983Medicare PIN