Provider Demographics
NPI:1063581262
Name:BOYNTON, LORIN DEBORA (MD)
Entity type:Individual
Prefix:DR
First Name:LORIN
Middle Name:DEBORA
Last Name:BOYNTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 9TH AVE # 359911
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2420
Mailing Address - Country:US
Mailing Address - Phone:206-485-0342
Mailing Address - Fax:206-970-5760
Practice Address - Street 1:19041 FRONT ST NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7354
Practice Address - Country:US
Practice Address - Phone:206-485-0342
Practice Address - Fax:206-970-5760
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000351932084B0040X
ORMD2183572084P0800X
WAMD000252092084P0800X
WA000351932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA260041193OtherRAILROAD MEDICARE
3642OtherINTERNAL ID-MOTOR VEHICLE ID
WA8246282Medicaid
3642OtherINTERNAL ID-MOTOR VEHICLE ID
WAAB10103Medicare PIN
WA260041193OtherRAILROAD MEDICARE