Provider Demographics
NPI:1255335899
Name:BOYD, WILLIAM E JR (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
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:PO BOX 457
Mailing Address - Street 2:200 POCAHONTAS TRIAIL
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-0457
Mailing Address - Country:US
Mailing Address - Phone:304-536-5030
Mailing Address - Fax:304-536-5051
Practice Address - Street 1:2501 VALLEY RIDGE RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426-6339
Practice Address - Country:US
Practice Address - Phone:540-862-4146
Practice Address - Fax:540-862-0131
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041245208000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006717454Medicaid
VA1255335899Medicaid
B07157Medicare UPIN
VA370001001Medicare PIN
VAVVJ554E984Medicare PIN