Provider Demographics
NPI:1750334413
Name:BOYD, STACY
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:974 N CASCADE DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-3141
Mailing Address - Country:US
Mailing Address - Phone:503-982-0403
Mailing Address - Fax:503-981-2249
Practice Address - Street 1:974 N CASCADE DR
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-3141
Practice Address - Country:US
Practice Address - Phone:503-982-0403
Practice Address - Fax:503-981-2249
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine