Healthcare Provider Details

I. General information

NPI: 1437423431
Provider Name (Legal Business Name): WILLIAM OMAR BOONE SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 NW EXPRESSWAY STE 200
OKLAHOMA CITY OK
73132-1522
US

IV. Provider business mailing address

PO BOX 30672
MIDWEST CITY OK
73140-3672
US

V. Phone/Fax

Practice location:
  • Phone: 405-525-0452
  • Fax:
Mailing address:
  • Phone: 405-821-7363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: