Provider Demographics
NPI:1609197862
Name:RICHARD B. BOYD, MD, PS
Entity Type:Organization
Organization Name:RICHARD B. BOYD, MD, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-575-1922
Mailing Address - Street 1:1111 W SPRUCE ST
Mailing Address - Street 2:SUITE 30
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3257
Mailing Address - Country:US
Mailing Address - Phone:509-575-1922
Mailing Address - Fax:509-248-2801
Practice Address - Street 1:1111 W SPRUCE ST
Practice Address - Street 2:SUITE 30
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3257
Practice Address - Country:US
Practice Address - Phone:509-575-1922
Practice Address - Fax:509-248-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00016580207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA06539Medicare UPIN