Provider Demographics
NPI:1063611028
Name:BOYD, HAROLD DALE (MD)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:DALE
Last Name:BOYD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 45443
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84145-0443
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:1747 BAPTIST CLAY RD STE 340
Practice Address - Street 2:CREDENTIALING DEPARTMENT
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-8503
Practice Address - Country:US
Practice Address - Phone:904-264-4405
Practice Address - Fax:904-391-5380
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57547207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00464685OtherRR MEDICARE
FLP00464685OtherRR MEDICARE
FL28436WMedicare PIN