Provider Demographics
NPI:1760923585
Name:BOYD, GERALD ANTHONY (CO, LO)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:ANTHONY
Last Name:BOYD
Suffix:
Gender:M
Credentials:CO, LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 S LINE DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4822
Mailing Address - Country:US
Mailing Address - Phone:407-884-5335
Mailing Address - Fax:407-884-4727
Practice Address - Street 1:114 S LINE DR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4822
Practice Address - Country:US
Practice Address - Phone:407-884-5335
Practice Address - Fax:407-884-4727
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist