Provider Demographics
NPI:1871689844
Name:HAMMOND, BOYD LEWIS (MEDICAL DOCTOR)
Entity type:Individual
Prefix:DR
First Name:BOYD
Middle Name:LEWIS
Last Name:HAMMOND
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 CHANNING WAY
Mailing Address - Street 2:STE 100A
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7531
Mailing Address - Country:US
Mailing Address - Phone:208-535-4567
Mailing Address - Fax:208-535-4569
Practice Address - Street 1:2860 CHANNING WAY
Practice Address - Street 2:STE 100A
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7531
Practice Address - Country:US
Practice Address - Phone:208-535-4567
Practice Address - Fax:208-535-4569
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM3747208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002478100Medicaid
ID1112137Medicare PIN
ID002478100Medicaid