=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437133949
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANET E. BOONE MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2005
-----------------------------------------------------
Last Update Date | 01/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4018 EL INDIO HWY
-----------------------------------------------------
City | EAGLE PASS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78852-6690
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-872-3460
-----------------------------------------------------
Fax | 830-872-3470
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1470
-----------------------------------------------------
City | EAGLE PASS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78853-1470
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-773-8917
-----------------------------------------------------
Fax | 830-773-1892
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | G6475
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------