Healthcare Provider Details

I. General information

NPI: 1033246731
Provider Name (Legal Business Name): ALAN WOODFORD BOONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 HOWARD ST
BANGOR ME
04401-5520
US

IV. Provider business mailing address

36 HOWARD ST
BANGOR ME
04401-5520
US

V. Phone/Fax

Practice location:
  • Phone: 207-945-3616
  • Fax:
Mailing address:
  • Phone: 207-945-3616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number005653
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: