Provider Demographics
NPI:1952462947
Name:BOYD, JAMES LESLIE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LESLIE
Last Name:BOYD
Suffix:JR
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 1:605 ASCADA CT
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-4916
Mailing Address - Country:US
Mailing Address - Phone:530-913-9632
Mailing Address - Fax:
Practice Address - Street 1:605 ASCADA CT
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4916
Practice Address - Country:US
Practice Address - Phone:530-913-9632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22310208000000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMS044210Medicaid