Healthcare Provider Details

I. General information

NPI: 1154301117
Provider Name (Legal Business Name): MICHAEL K BOONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N LEE TREVINO DR STE B
EL PASO TX
79936-2116
US

IV. Provider business mailing address

3100 N LEE TREVINO DR STE B
EL PASO TX
79936-2116
US

V. Phone/Fax

Practice location:
  • Phone: 915-533-7465
  • Fax: 915-534-1185
Mailing address:
  • Phone: 915-533-7465
  • Fax: 915-534-1185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberH4177
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: