Provider Demographics
NPI:1821171927
Name:BOYD, CRAIG W (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:W
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 1:621 S NEW BALLAS RD STE 101A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8252
Mailing Address - Country:US
Mailing Address - Phone:314-569-2751
Mailing Address - Fax:314-997-0211
Practice Address - Street 1:621 S NEW BALLAS RD STE 101A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8252
Practice Address - Country:US
Practice Address - Phone:314-569-2751
Practice Address - Fax:314-997-0211
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9D21207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA10493Medicare UPIN
MO122950079Medicare PIN