Provider Demographics
NPI:1750839502
Name:LAYTON, BOYD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BOYD
Middle Name:
Last Name:LAYTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-302-3200
Mailing Address - Fax:208-302-3255
Practice Address - Street 1:4424 E FLAMINGO AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-9289
Practice Address - Country:US
Practice Address - Phone:208-302-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-1405363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical