Provider Demographics
NPI:1770581456
Name:BOYD, WILLIAM MARC JR (DO, MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MARC
Last Name:BOYD
Suffix:JR
Gender:M
Credentials:DO, MD
Other - Prefix:
Other - First Name:W
Other - Middle Name:MARC
Other - Last Name:BOYD
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DO, MD
Mailing Address - Street 1:PO BOX 17567
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32522-7567
Mailing Address - Country:US
Mailing Address - Phone:850-475-3700
Mailing Address - Fax:850-505-0079
Practice Address - Street 1:3417 N 12TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-4008
Practice Address - Country:US
Practice Address - Phone:850-432-7310
Practice Address - Fax:850-432-7320
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084069207V00000X
ALDO.2106207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036084069Medicaid
IL07205412OtherBC/BS
IL263252OtherHEALTHLINK
ILF56102Medicare UPIN
IL036084069Medicaid