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General NPI Number Information
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NPI Number | 1417913260
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Entity Type | Organization
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Legal Business Name | BOONE DERMATOLOGY CLINIC
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Dates
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Enumeration Date | 04/21/2006
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Last Update Date | 04/13/2015
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Provider Practice Location Address
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Address Line | 169 BIRCH ST
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City | BOONE
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State | NC
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Zip | 28607-5069
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Country | US
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Telephone | 828-264-4553
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Fax | 828-262-3649
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Provider Business Mailing Address
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Address Line | 169 BIRCH ST
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City | BOONE
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State | NC
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Zip | 28607-5069
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Country | US
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Telephone | 828-264-4553
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Fax | 828-262-3649
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Authorized Official
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Title or Position | PRESIDENT
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Name | RONALD J STANLEY
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Credential | MD
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Telephone | 828-264-4553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 18060
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 25707
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 200000665
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 200500862
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 39986
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License Number State | NC
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