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NPI Code Detail

MEDICARE: VERA BOONE PA

MEDICARE: VERA BOONE PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1437124369
Entity Type Code : Individual
Provider Name (Legal Business Name) : VERA BOONE PA
Provider Business Mailing Address
First Line : 10109 E 79TH ST
Second Line :
City : TULSA
State : OK
Zip : 74133-4564
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2330 PAYSPHERE CIR
Second Line :
City : CHICAGO
State : IL
Zip : 60674-0023
Country : US
Telephone Number : 847-746-4358
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2006
Last Update Date : 07/09/2007

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