Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | A165077 | CA |
NPI | 1225425002 |
---|---|
Provider Name | Dr. Timothy O'keefe Boone JR. |
First Address | San Francisco, CA 94114-3840 |
Second Address | San Francisco, CA 94114-3840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2015 |
Last Update Date | 10/10/2019 |