Provider Demographics
NPI:1275146664
Name:BOYDSNEE, ZACHARIAH JACOB CHARLES (IDC)
Entity type:Individual
Prefix:
First Name:ZACHARIAH
Middle Name:JACOB CHARLES
Last Name:BOYDSNEE
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 100177 BOX 1
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96661-7700
Mailing Address - Country:US
Mailing Address - Phone:315-243-0754
Mailing Address - Fax:
Practice Address - Street 1:COMMANDING OFFICER
Practice Address - Street 2:USS BENFOLD (DDG 65)
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96661
Practice Address - Country:US
Practice Address - Phone:615-243-0754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman