Provider Demographics
NPI:1609895382
Name:BOYD, RUSSELL WAYNE (M D)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:WAYNE
Last Name:BOYD
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 TYSON AVE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-4544
Mailing Address - Country:US
Mailing Address - Phone:731-644-3211
Mailing Address - Fax:731-644-1552
Practice Address - Street 1:235 TYSON AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4544
Practice Address - Country:US
Practice Address - Phone:731-644-3211
Practice Address - Fax:731-644-1552
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD31389208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00287155OtherRAILROAD MEDICARE INDIVID
TN3837542Medicaid
TN4075412OtherBLUECROSS BLUESHIELD NUMB
TNDB4003OtherRAILROAD MEDICARE GROUP
TNP00287155OtherRAILROAD MEDICARE INDIVID
TN3724040Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER