Provider Demographics
NPI:1336153808
Name:BOYD, WHITSON HINES (PA-C)
Entity Type:Individual
Prefix:
First Name:WHITSON
Middle Name:HINES
Last Name:BOYD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1549 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-1651
Mailing Address - Country:US
Mailing Address - Phone:850-997-0707
Mailing Address - Fax:850-997-6833
Practice Address - Street 1:1549 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344-1651
Practice Address - Country:US
Practice Address - Phone:850-997-0707
Practice Address - Fax:850-997-6833
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102923363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292729200Medicaid
FL292729200Medicaid
FLAC927ZMedicare PIN