Provider Demographics
NPI:1962459800
Name:BOYD, GWENDOLYN L (MD)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:L
Last Name:BOYD
Suffix:
Gender:F
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:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:619 19TH STREET SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233
Practice Address - Country:US
Practice Address - Phone:205-934-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11728207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051511173OtherBLUE CROSS
GA3387534OtherGEORGIA MEDICAID
AL01003CC67472OtherSECTION 1011
AL2319OtherHEALTHSPRING
MS00111281OtherMISSISSIPPI MEDICAID
AL009998985Medicaid
FL900847100OtherFLORIDA MEDICAID
AL051511172OtherBLUE CROSS
ALC67472OtherVIVA
AL000013257OtherBLUE CROSS
AL000013257Medicaid
AL000013257Medicare PIN
AL050045665Medicare PIN