Provider Demographics
NPI:1164440020
Name:BOONE, ROBERT DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DANIEL
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 1:410 UNIVERSITY PARKWAY
Mailing Address - Street 2:STE 1550
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801
Mailing Address - Country:US
Mailing Address - Phone:803-649-7535
Mailing Address - Fax:803-648-8771
Practice Address - Street 1:410 UNIVERSITY PARKWAY
Practice Address - Street 2:STE 1550
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801
Practice Address - Country:US
Practice Address - Phone:803-649-7535
Practice Address - Fax:803-648-8771
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11835207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC118358Medicaid
SC118358Medicaid
Q239081757Medicare ID - Type Unspecified