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General NPI Number Information
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NPI Number | 1730151457
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Entity Type | Individual
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Provider Name | BRADLEY A BOONE M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/06/2006
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 3201 S AUSTIN AVE
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City | GEORGETOWN
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State | TX
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Zip | 78626-7545
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Country | US
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Telephone | 512-459-8753
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Fax | 512-483-6807
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Provider Business Mailing Address
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Address Line | 2111 14TH ST
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City | MERIDIAN
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State | MS
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Zip | 39301-4041
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Country | US
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Telephone | 601-693-3834
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Fax | 601-484-3225
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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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 44117
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | P8338
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License Number State | TX
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