Provider Demographics
NPI:1659440774
Name:BOYD, ROBERT EARL III (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EARL
Last Name:BOYD
Suffix:III
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 1:200 SHOREWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-8972
Mailing Address - Country:US
Mailing Address - Phone:815-744-3036
Mailing Address - Fax:815-744-3042
Practice Address - Street 1:333 NORTH MADISON STREET
Practice Address - Street 2:PROVENA SAINT JOSEPH MEDICAL CENTER
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435
Practice Address - Country:US
Practice Address - Phone:815-741-7200
Practice Address - Fax:815-741-7591
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA342992085R0202X
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0009915352OtherBCBS
0009915352OtherBCBS
0009915352OtherBCBS
ILP00993Medicare ID - Type Unspecified