Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | N2957 | TX |
NPI | 1013154384 |
---|---|
Provider Name | Dr. John Reynolds Boon |
First Address | Sugar Land, TX 77479-2345 |
Second Address | Sugar Land, TX 77479-2345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2009 |
Last Update Date | 12/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1813154384 | BLUE CROSS BLUE SHIELD (01) | TX |
280592101 | (05) | TX |
280592102 | (05) | TX |
P00748658 | RAILROAD MEDICARE (01) | TX |
P01062995 | RAILROAD MEDICARE (01) | TX |