Provider Demographics
NPI:1699726083
Name:BOYD, SCOTT T (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:T
Last Name:BOYD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16909 BURKE ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-2268
Mailing Address - Country:US
Mailing Address - Phone:402-932-1644
Mailing Address - Fax:402-763-8437
Practice Address - Street 1:16909 BURKE ST
Practice Address - Street 2:210
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-2268
Practice Address - Country:US
Practice Address - Phone:402-932-1644
Practice Address - Fax:402-763-8437
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42618207L00000X
TXS8964207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA60583223Medicaid
COCO400060Medicare PIN
COCOB4060Medicare PIN
CA60583223Medicaid