Provider Demographics
NPI:1629124300
Name:BOYDSTON, JOANNA (MD)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:BOYDSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6011 E WOODMEN RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2602
Mailing Address - Country:US
Mailing Address - Phone:719-884-9962
Mailing Address - Fax:719-884-9963
Practice Address - Street 1:6011 E WOODMEN RD
Practice Address - Street 2:SUITE 305
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2602
Practice Address - Country:US
Practice Address - Phone:719-884-9962
Practice Address - Fax:719-884-9963
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47723207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology