Provider Demographics
NPI:1689769739
Name:BOYINGTON, ROGER T (DO)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:T
Last Name:BOYINGTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-1205
Mailing Address - Country:US
Mailing Address - Phone:334-427-2273
Mailing Address - Fax:334-222-2583
Practice Address - Street 1:508 E THREE NOTCH ST
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-3128
Practice Address - Country:US
Practice Address - Phone:334-427-2273
Practice Address - Fax:334-222-2583
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO439207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529901030Medicaid
AL51078763OtherBLUE CROSS BLUE SHIELD AL
AL000078763OtherMEDICARE
AL51078763OtherBLUE CROSS BLUE SHIELD AL
AL000078763Medicare ID - Type Unspecified