Provider Demographics
NPI:1669493078
Name:BOYD, JULIA ANN (MD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ANN
Last Name:BOYD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6611 CLYO RD
Mailing Address - Street 2:STE B
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2786
Mailing Address - Country:US
Mailing Address - Phone:937-208-7474
Mailing Address - Fax:937-208-7470
Practice Address - Street 1:6611 CLYO RD
Practice Address - Street 2:STE B
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-2786
Practice Address - Country:US
Practice Address - Phone:937-208-7474
Practice Address - Fax:937-208-7470
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057343207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0788867Medicaid
OH0669706Medicare PIN
OH0788867Medicaid