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General NPI Number Information
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NPI Number | 1447247986
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Entity Type | Organization
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Legal Business Name | EDGAR A BOONE JOY L BOONE MD
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 01/24/2008
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Provider Practice Location Address
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Address Line | 401 CHURCH ST
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City | HERMINIE
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State | PA
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Zip | 15637-1457
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Country | US
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Telephone | 724-446-5571
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Fax | 724-446-2151
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Provider Business Mailing Address
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Address Line | 401 CHURCH ST
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City | HERMINIE
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State | PA
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Zip | 15637-1457
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Country | US
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Telephone | 724-446-5571
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Fax | 724-446-2151
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDGAR A BOONE
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Credential | MD
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Telephone | 724-446-5571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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