Healthcare Provider Details

I. General information

NPI: 1033121900
Provider Name (Legal Business Name): GEORGE DANIEL BOONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAHACIENDA TREATMENT CENTER
HUNT TX
78024
US

IV. Provider business mailing address

1365 SADDLEWOOD BLVD
KERRVILLE TX
78028-7231
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 Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberF6460
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberF6460
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: