Provider Demographics
NPI:1386715514
Name:BOYD, BRUCE K (DPM)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:K
Last Name:BOYD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 ALCORN DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-8400
Mailing Address - Country:US
Mailing Address - Phone:662-286-2700
Mailing Address - Fax:
Practice Address - Street 1:211 ALCORN DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-8400
Practice Address - Country:US
Practice Address - Phone:662-286-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM0000000341213EP1101X
MS80100213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7917OtherTLC
TNUNITED HEALTHCAREOther2700155
MS00110447Medicaid
TN2005806OtherBCBS OF TN
MST82067Medicare UPIN
4563110001Medicare NSC
MS480000070Medicare PIN
7917OtherTLC
TNT82067Medicare UPIN
MS480000032Medicare PIN