Healthcare Provider Details

I. General information

NPI: 1538191663
Provider Name (Legal Business Name): SCOTT ALLEN BOONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 E PRINCETON ST SUITE 200
ORLANDO FL
32804-5553
US

IV. Provider business mailing address

235 E PRINCETON ST SUITE 200
ORLANDO FL
32804-5553
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-1444
  • Fax: 407-303-1446
Mailing address:
  • Phone: 407-303-1444
  • Fax: 407-303-1446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME 40466
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: