Provider Demographics
NPI:1033121900
Name:BOONE, GEORGE DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:DANIEL
Last Name:BOONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1365 SADDLEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-7231
Mailing Address - Country:US
Mailing Address - Phone:830-238-6123
Mailing Address - Fax:830-238-5140
Practice Address - Street 1:LAHACIENDA TREATMENT CENTER
Practice Address - Street 2:
Practice Address - City:HUNT
Practice Address - State:TX
Practice Address - Zip Code:78024
Practice Address - Country:US
Practice Address - Phone:830-238-6123
Practice Address - Fax:830-238-5140
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6460207RA0401X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C13602Medicare UPIN