Provider Demographics
NPI:1114627395
Name:BONEY, MATTHEW LA TOURA (ESQ)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:LA TOURA
Last Name:BONEY
Suffix:
Gender:M
Credentials:ESQ
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 1744
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-1744
Mailing Address - Country:US
Mailing Address - Phone:336-706-7625
Mailing Address - Fax:910-259-7464
Practice Address - Street 1:113 SOUTH WRIGHT STREET
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425
Practice Address - Country:US
Practice Address - Phone:336-706-7625
Practice Address - Fax:910-259-7464
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC6869253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care