Provider Demographics
NPI:1346352317
Name:BOONE, MAX R (MD)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:R
Last Name:BOONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:22289 MEDICAL VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35613-2896
Mailing Address - Country:US
Mailing Address - Phone:256-232-1414
Mailing Address - Fax:256-230-2610
Practice Address - Street 1:22289 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35613-2896
Practice Address - Country:US
Practice Address - Phone:256-232-1414
Practice Address - Fax:256-230-2610
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL15144174400000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist