Provider Demographics
NPI:1104213313
Name:BOYKIN, GARY LEE II
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:LEE
Last Name:BOYKIN
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 DOMINION DR APT 4
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-5529
Mailing Address - Country:US
Mailing Address - Phone:330-945-0053
Mailing Address - Fax:
Practice Address - Street 1:1702 DOMINION DR APT 4
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-5529
Practice Address - Country:US
Practice Address - Phone:330-945-0053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-26
Last Update Date:2015-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401716530115376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide