Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 55411 | TN |
NPI | 1235457151 |
---|---|
Provider Name | Jonathan David Boone |
First Address | Birmingham, AL 35233-1802 |
Second Address | Knoxville, TN 37920-1545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2010 |
Last Update Date | 01/08/2017 |