Healthcare Provider Details

I. General information

NPI: 1194380659
Provider Name (Legal Business Name): DANIEL EVAN BOYKIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4022 POSTAL WAY
MYRTLE BEACH SC
29579-3537
US

IV. Provider business mailing address

300 SINGLETON RIDGE RD ATTN PNS CREDENTIALING
CONWAY SC
29526-9142
US

V. Phone/Fax

Practice location:
  • Phone: 843-236-0000
  • Fax: 843-236-6191
Mailing address:
  • Phone: 843-234-6946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number90043
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: