Provider Demographics
NPI:1497763072
Name:BOYKOFF, TERRY JAY (DPM)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:JAY
Last Name:BOYKOFF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 15TH ST
Mailing Address - Street 2:SUITE 1014
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1135
Mailing Address - Country:US
Mailing Address - Phone:310-451-1618
Mailing Address - Fax:
Practice Address - Street 1:1260 15TH ST
Practice Address - Street 2:SUITE 1014
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1135
Practice Address - Country:US
Practice Address - Phone:310-451-1618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2764213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Not Answered213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T11457Medicare UPIN
E2764Medicare ID - Type Unspecified
WE6504Medicare ID - Type Unspecified