Basic Information
| Provider Information | |||||||||
| NPI: | 1669517769 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOYD | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | ALAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 919 HIDDEN RDG | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750383813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4692822711 | ||||||||
| FaxNumber: | 4692822609 | ||||||||
| Practice Location | |||||||||
| Address1: | 1311 GENERAL CAVAZOS BLVD | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | KINGSVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 783637129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3615922223 | ||||||||
| FaxNumber: | 3615921967 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2007 | ||||||||
| LastUpdateDate: | 04/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | M5646 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | P02601725 | 01 | TX | MCRR | OTHER | 188839801 | 05 | TX | MEDICAID | 188839803 | 05 | TX | MEDICAID | 1L4970 | 01 | TX | MEDICARE | OTHER | 8X7949 | 01 | TX | BCBS | OTHER | 188839802 | 05 | TX | MEDICAID |