1033546148 NPI number — DR. DAVID F BOYD III FNP STUDENT

Table of content: DR. DAVID F BOYD III FNP STUDENT (NPI 1033546148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033546148 NPI number — DR. DAVID F BOYD III FNP STUDENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYD
Provider First Name:
DAVID
Provider Middle Name:
F
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
FNP STUDENT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOYD
Provider Other First Name:
DAVID
Provider Other Middle Name:
F
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
III
Provider Other Credential Text:
FNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1033546148
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
126 MISSOURI AVE.
Provider Second Line Business Mailing Address:
GENERAL LEONARD WOOD COMMUNITY HOSPITAL
Provider Business Mailing Address City Name:
WAYNESVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65473
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-596-0462
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
126 MISSOURI AVE
Provider Second Line Business Practice Location Address:
GENERAL LEONARD WOOD COMMUNITY HOSPITAL
Provider Business Practice Location Address City Name:
FORT LEONARD WOOD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65473-8952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-596-0462
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  38436.1547 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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