Provider Demographics
NPI:1205875929
Name:BOYD, DEBORAH L (DO)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:BOYD
Suffix:
Gender:F
Credentials:DO
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 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:5414 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1335
Practice Address - Country:US
Practice Address - Phone:903-581-1601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5974207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BP162OtherBCBS
TX128814403Medicaid
TX75-0818167-015OtherTRICARE
TX0042GKOtherBCBS
TX8EX136OtherBCBS
TX128814410Medicaid
TX75-0818167-044OtherTRICARE
TX75-0818167-048OtherTRICARE
TX128814404Medicaid
TX75-0818167-044OtherTRICARE
TX128814410Medicaid
TX930100056Medicare PIN