Basic Information
| Provider Information | |||||||||
| NPI: | 1750848099 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOYD | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4848 CLARK RD | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487569396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103345833 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2255 S LINDEN RD STE A | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485325417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107328087 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2019 | ||||||||
| LastUpdateDate: | 02/22/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 4704248691 | MI | Y | Nursing Service Providers | Registered Nurse |
No ID Information.