Provider Demographics
NPI:1891772596
Name:BOYKIN, IAN (MD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:
Last Name:BOYKIN
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 1:2000 NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4833
Mailing Address - Country:US
Mailing Address - Phone:772-465-4444
Mailing Address - Fax:772-465-4499
Practice Address - Street 1:2000 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4833
Practice Address - Country:US
Practice Address - Phone:772-465-4444
Practice Address - Fax:772-466-4499
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL80735207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010598341OtherCOMMERCIAL INSURANCE
FL80735OtherMEDICAL LICENSE
FL51697OtherBLUECROSS BLUE SHIELD
FL51697Medicare ID - Type UnspecifiedMEDICARE
FL010598341OtherCOMMERCIAL INSURANCE
FLH23986Medicare UPIN