Healthcare Provider Details

I. General information

NPI: 1790131886
Provider Name (Legal Business Name): DAVID LYNN BOONE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 WEST MEDICAL BLVD SUITE 510
WEBSTER TX
77598
US

IV. Provider business mailing address

4010 CHARLESTON ST
HOUSTON TX
77021-1412
US

V. Phone/Fax

Practice location:
  • Phone: 832-972-7300
  • Fax: 713-575-3689
Mailing address:
  • Phone: 832-972-7300
  • Fax: 855-538-7649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number2025048581
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberR4192
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberR4192
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: