Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | F6460 | TX |
Y | 111NI0900X | Internist | F6460 | TX |
N | 207RA0401X | Internist - Addiction Medicine | F6460 | TX |
NPI | 1033121900 |
---|---|
Provider Name | Dr. George Daniel Boone |
First Address | Kerrville, TX 78028-7231 |
Second Address | Hunt, TX 78024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 18/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C13602 | (02) |