Healthcare Provider Details

I. General information

NPI: 1043396211
Provider Name (Legal Business Name): JAMES CARROLL BOONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 LA HACIENDA WAY
HUNT TX
78024
US

IV. Provider business mailing address

PO BOX 293370
KERRVILLE TX
78029-3370
US

V. Phone/Fax

Practice location:
  • Phone: 830-238-6123
  • Fax: 830-238-5140
Mailing address:
  • Phone: 830-238-6123
  • Fax: 830-238-5140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number68012
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberG8012
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberG8012
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: