Provider Demographics
NPI:1679501050
Name:BOYD, CHERYL ANN (DO)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANN
Last Name:BOYD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8439 N 117TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-2142
Mailing Address - Country:US
Mailing Address - Phone:918-272-8989
Mailing Address - Fax:918-272-4185
Practice Address - Street 1:8439 N 117TH EAST AVE
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-2142
Practice Address - Country:US
Practice Address - Phone:918-272-8989
Practice Address - Fax:918-272-4185
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3442208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100034090BMedicaid
OK100034090BMedicaid