Provider Demographics
NPI:1578505319
Name:BOYD, JAMES WILSON (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILSON
Last Name:BOYD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 S HURSTBOURNE PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5757
Mailing Address - Country:US
Mailing Address - Phone:502-583-2731
Mailing Address - Fax:
Practice Address - Street 1:1230 S HURSTBOURNE PKWY STE 210
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5757
Practice Address - Country:US
Practice Address - Phone:502-583-2731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS109402085R0202X
TN150982085R0202X
KY513442085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00017738Medicaid
KY7100036480Medicaid
AL009700270Medicaid
MS300020465OtherRAILROAD MEDICARE
TN3009299Medicaid
MS300000080Medicare PIN
MS00017738Medicaid
AL051557192Medicare PIN
MS300001090Medicare PIN