Provider Demographics
NPI:1679548721
Name:BOYD, ALBERT ODILI (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:ODILI
Last Name:BOYD
Suffix:
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 1:941 YORK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2066
Mailing Address - Country:US
Mailing Address - Phone:972-296-7500
Mailing Address - Fax:972-296-7588
Practice Address - Street 1:941 YORK DR STE 200
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2066
Practice Address - Country:US
Practice Address - Phone:972-296-7500
Practice Address - Fax:972-296-7588
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14666OtherPARKLAND
TX4205433OtherCIGNA
TX10012782OtherAMERIGROUP
TX1627911OtherTPI
TX7751501OtherAETNA
TX0023LBOtherBCBS
TX1627911OtherTPI
TX7751501OtherAETNA