Provider Demographics
NPI:1881097798
Name:BRUCE K.BOYD DPM
Entity type:Organization
Organization Name:BRUCE K.BOYD DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:662-286-2700
Mailing Address - Street 1:1950 PICKWICK ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-5309
Mailing Address - Country:US
Mailing Address - Phone:662-286-2700
Mailing Address - Fax:662-286-2773
Practice Address - Street 1:1950 PICKWICK ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-5309
Practice Address - Country:US
Practice Address - Phone:662-286-2700
Practice Address - Fax:662-286-2773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM0000000341213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty