Healthcare Provider Details

I. General information

NPI: 1821062571
Provider Name (Legal Business Name): JOHN LEIGH BOONE
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 N SARATOGA ST
OAK HARBOR WA
98278-4927
US

IV. Provider business mailing address

PO BOX 319
GREENBANK WA
98253-0319
US

V. Phone/Fax

Practice location:
  • Phone: 360-257-9975
  • Fax:
Mailing address:
  • Phone: 360-678-8084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA41247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: