Healthcare Provider Details

I. General information

NPI: 1093747552
Provider Name (Legal Business Name): CATHERINE GRACE BOON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE G BOON

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-0371
US

IV. Provider business mailing address

PO BOX 13833
PHILADELPHIA PA
19101-3833
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-5500
  • Fax: 352-333-0174
Mailing address:
  • Phone: 352-333-5500
  • Fax: 352-265-0627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME72345
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: