Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 56270 | MN |
NPI | 1609035781 |
---|---|
Provider Name | Dr. John Luther Boone |
First Address | Edina, MN 55435-2187 |
Second Address | Edina, MN 55435-2187 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2008 |
Last Update Date | 08/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1609035781 | (05) | MN |