Healthcare Provider Details

I. General information

NPI: 1326042979
Provider Name (Legal Business Name): BOONE PODIATRY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 STATE FARM RD STE C
BOONE NC
28607-4738
US

IV. Provider business mailing address

610 STATE FARM RD STE C
BOONE NC
28607-4738
US

V. Phone/Fax

Practice location:
  • Phone: 828-265-3668
  • Fax:
Mailing address:
  • Phone: 828-265-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number354
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number354
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number354
License Number StateNC

VIII. Authorized Official

Name: PAUL ZIMMERMAN
Title or Position: PODIATRIST/ OWNER
Credential: DPM
Phone: 828-265-3668