Provider Demographics
NPI:1043396211
Name:BOONE, JAMES CARROLL (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CARROLL
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 293370
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78029-3370
Mailing Address - Country:US
Mailing Address - Phone:830-238-6123
Mailing Address - Fax:830-238-5140
Practice Address - Street 1:145 LA HACIENDA WAY
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?:No
Enumeration Date:2006-10-31
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68012207R00000X
TXG8012207RA0401X, 2083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C13610Medicare UPIN