Provider Demographics
NPI:1033220520
Name:BOONE, ROBERT FLOYD (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:FLOYD
Last Name:BOONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5579
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-5579
Mailing Address - Country:US
Mailing Address - Phone:541-706-4701
Mailing Address - Fax:541-706-4751
Practice Address - Street 1:2500 NE NEFF RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6015
Practice Address - Country:US
Practice Address - Phone:541-706-4701
Practice Address - Fax:541-706-4751
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13548174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR00417826OtherRAILROAD MEDICARE
OR290379Medicaid
OR049WCGMFAMedicare ID - Type Unspecified
ORC97190Medicare UPIN