Provider Demographics
NPI:1902914179
Name:BOYNTON, GERARD W (MD)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:W
Last Name:BOYNTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3301 S ALAMEDA ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1892
Mailing Address - Country:US
Mailing Address - Phone:361-452-2480
Mailing Address - Fax:361-452-2484
Practice Address - Street 1:3301 S ALAMEDA ST
Practice Address - Street 2:SUITE 212
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1892
Practice Address - Country:US
Practice Address - Phone:361-452-2480
Practice Address - Fax:361-452-2484
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2017-03-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF3771207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1346562410Medicaid
B21441Medicare UPIN