Provider Demographics
NPI:1427148634
Name:BOYD, ROBERT MARK (PHYSICIAN ASSISATANT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MARK
Last Name:BOYD
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISATANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5352 BECKLEY RD STE B
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-4155
Mailing Address - Country:US
Mailing Address - Phone:269-558-0714
Mailing Address - Fax:
Practice Address - Street 1:5350 BECKLEY RD STE B
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-4178
Practice Address - Country:US
Practice Address - Phone:269-781-4271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK677363A00000X
CAPA16861363A00000X
WI3262-23363A00000X
MI5601011632363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKQ52203Medicare UPIN
AK160361Medicare ID - Type Unspecified