Provider Demographics
NPI:1528009735
Name:BOYUM, ALLAN JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:JAMES
Last Name:BOYUM
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 1:26242 STILLWATER CIR
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33955-4731
Mailing Address - Country:US
Mailing Address - Phone:612-423-1127
Mailing Address - Fax:
Practice Address - Street 1:26242 STILLWATER CIR
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33955-4731
Practice Address - Country:US
Practice Address - Phone:612-423-2202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN15643207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN426772900Medicaid
A94901Medicare UPIN
110001218Medicare ID - Type Unspecified