Provider Demographics
NPI:1306010863
Name:BOONE, JEFFREY L (MD, MS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:BOONE
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7355 E ORCHARD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2511
Mailing Address - Country:US
Mailing Address - Phone:303-762-0710
Mailing Address - Fax:303-806-9533
Practice Address - Street 1:7355 E ORCHARD RD STE 100
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111
Practice Address - Country:US
Practice Address - Phone:303-762-0710
Practice Address - Fax:303-806-9533
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COBB0622274207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
COF05244Medicare UPIN