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General NPI Number Information
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NPI Number | 1578950044
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Entity Type | Individual
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Provider Name | JOHN BRADFORD BOONE M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/22/2015
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Last Update Date | 04/22/2015
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Provider Practice Location Address
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Address Line | 1161 21ST AVE S D3100 MEDICAL CENTER NORTH
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City | NASHVILLE
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State | TN
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Zip | 37232-0011
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Country | US
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Telephone | 615-322-0417
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Fax |
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Provider Business Mailing Address
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Address Line | 101 NATIVE TRCE
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-6011
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Country | US
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Telephone | 859-489-8036
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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