Provider Demographics
NPI:1245293075
Name:BOYNTON, STEVEN EDWARD (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:EDWARD
Last Name:BOYNTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:23400 US HIGHWAY 160
Mailing Address - Street 2:
Mailing Address - City:WALSENBURG
Mailing Address - State:CO
Mailing Address - Zip Code:81089-8100
Mailing Address - Country:US
Mailing Address - Phone:719-738-4590
Mailing Address - Fax:719-738-4553
Practice Address - Street 1:9040 JACKSON AVE MCHJ-QSD-C CREDENTIALS OFFICE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-8100
Practice Address - Country:US
Practice Address - Phone:253-968-0554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0050701207Q00000X
TXK0270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO61639745Medicaid
TX8F3398Medicare PIN
TX5892790001Medicare NSC
TX100116105OtherFIRSTCARE
TX131133409Medicaid
TX5892790001Medicare NSC
TX5905693OtherAETNA
TX8W0410OtherBCBS