Healthcare Provider Details

I. General information

NPI: 1326037268
Provider Name (Legal Business Name): CRYSTAL AMOS BOYKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CRYSTAL F AMOS M.D.

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 04/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 CREEKWOOD CT
SPRINGFIELD OH
45504-4056
US

IV. Provider business mailing address

2555 CREEKWOOD CT
SPRINGFIELD OH
45504-4056
US

V. Phone/Fax

Practice location:
  • Phone: 937-327-0552
  • Fax: 937-327-0556
Mailing address:
  • Phone: 937-327-0552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-06-3808-A
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: