Provider Demographics
NPI:1437212610
Name:BOYNTON, DOUGLAS L (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:L
Last Name:BOYNTON
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 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:400 8TH ST N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5519
Practice Address - Country:US
Practice Address - Phone:239-649-3303
Practice Address - Fax:239-649-3392
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046265900Medicaid
FL080011814OtherRRMC
FL03850OtherBCBS
FL080011814OtherRRMC
FL046265900Medicaid