Provider Demographics
NPI:1770546574
Name:BOYD, WILLIE L (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:L
Last Name:BOYD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2719 MIDDLEBURG DR
Mailing Address - Street 2:STE 203
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2414
Mailing Address - Country:US
Mailing Address - Phone:803-771-6277
Mailing Address - Fax:803-771-6278
Practice Address - Street 1:2719 MIDDLEBURG DR
Practice Address - Street 2:SUITE 203
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2414
Practice Address - Country:US
Practice Address - Phone:803-771-6277
Practice Address - Fax:803-771-6278
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9198207W00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC009198Medicaid
SCE09249Medicare UPIN
SCE092494230Medicare ID - Type UnspecifiedMEDICARE
SCE092494230Medicare UPIN
SC4230Medicare PIN