Provider Demographics
NPI:1093747552
Name:BOON, CATHERINE GRACE (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:GRACE
Last Name:BOON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:G
Other - Last Name:BOON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 13833
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-3833
Mailing Address - Country:US
Mailing Address - Phone:352-333-5500
Mailing Address - Fax:352-265-0627
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0371
Practice Address - Country:US
Practice Address - Phone:352-333-5500
Practice Address - Fax:352-333-0174
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72345208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009707100Medicaid
FL009707100Medicaid
G69300Medicare UPIN
FLHO830ZMedicare PIN