Provider Demographics
NPI:1174629893
Name:BOONE, HOWARD A (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:A
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 1076
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96160-1076
Mailing Address - Country:US
Mailing Address - Phone:530-587-1272
Mailing Address - Fax:530-587-2015
Practice Address - Street 1:10956 DONNER PASS RD STE 310
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4861
Practice Address - Country:US
Practice Address - Phone:530-587-1272
Practice Address - Fax:530-587-2015
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC343900208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C343900Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
CAA35608Medicare UPIN