Healthcare Provider Details

I. General information

NPI: 1982542411
Provider Name (Legal Business Name): CLAUDE BOONE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1584 W LAUREL AVE
GILBERT AZ
85233-4130
US

IV. Provider business mailing address

1584 W LAUREL AVE
GILBERT AZ
85233-4130
US

V. Phone/Fax

Practice location:
  • Phone: 602-586-9737
  • Fax: 480-780-0728
Mailing address:
  • Phone: 602-586-9737
  • Fax: 480-780-0728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberD10349380
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: