Basic Information
| Provider Information | |||||||||
| NPI: | 1215162417 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOYD | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 1ST ST SW | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 559050001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6087850940 | ||||||||
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| Practice Location | |||||||||
| Address1: | 191 THEATER RD | ||||||||
| Address2: | |||||||||
| City: | ONALASKA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 546508679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6087850940 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2009 | ||||||||
| LastUpdateDate: | 10/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207NP0225X | 67159 | MN | N | Allopathic & Osteopathic Physicians | Dermatology | Pediatric Dermatology | 207ZD0900X | 28372 | AL | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZD0900X | DR.0057606 | CO | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207N00000X | 21112 | WI | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.