Provider Demographics
NPI:1932242302
Name:BOYD, BRIAN J W (MD)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:J W
Last Name:BOYD
Suffix:
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 1:1140 WEST LA VETA
Mailing Address - Street 2:STE 410
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4226
Mailing Address - Country:US
Mailing Address - Phone:714-285-0615
Mailing Address - Fax:714-285-0619
Practice Address - Street 1:1140 WEST LA VETA
Practice Address - Street 2:STE 410
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4226
Practice Address - Country:US
Practice Address - Phone:714-285-0615
Practice Address - Fax:714-285-0619
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG596542084N0400X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE88705Medicare UPIN
CAG59654Medicare ID - Type Unspecified