Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 0103-301097 | VA |
Y | 222Z00000X | Podiatrist | 0103-301097 | VA |
N | 213EP1101X | Primary Podiatric Medicine | 0103-301097 | VA |
NPI | 1134553787 |
---|---|
Provider Name | Dr. Caesar Antonio Boone |
First Address | Fort Washington, MD 20744-3115 |
Second Address | Fort Washington, MD 20744-3115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2013 |
Last Update Date | 29/08/2013 |