Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 01069455A | IN |
NPI | 1104950799 |
---|---|
Provider Name | Dr. Win Boon |
First Address | Fort Wayne, IN 46825-1545 |
Second Address | Fort Wayne, IN 46845-1701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 25/03/2013 |