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General NPI Number Information
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NPI Number | 1679646046
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Entity Type | Individual
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Provider Name | NORRIS IVAN BOONE M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3600 SANDY FLAT RD
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City | TAYLORS
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State | SC
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Zip | 29687-6216
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Country | US
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Telephone | 864-354-7415
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Fax | 834-834-8581
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Provider Business Mailing Address
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Address Line | 3600 SANDY FLAT RD
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City | TAYLORS
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State | SC
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Zip | 29687-6216
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Country | US
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Telephone | 864-354-7415
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Fax | 834-834-8581
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 6584
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License Number State | SC
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