Provider Demographics
NPI:1710191101
Name:BOYD, JERRY RICHARD JR (FP-C / NCP)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:RICHARD
Last Name:BOYD
Suffix:JR
Gender:M
Credentials:FP-C / NCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 N UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-4039
Mailing Address - Country:US
Mailing Address - Phone:337-291-3379
Mailing Address - Fax:
Practice Address - Street 1:2916 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-4039
Practice Address - Country:US
Practice Address - Phone:337-291-3379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2016-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX707579146L00000X
2827687 (USCG LIC)174400000X
M0916413 (NATL REG)146L00000X
0003545 (BCCTPC)146L00000X
1710I1002X
115004 (RMP)174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman