Provider Demographics
NPI:1407117138
Name:JOHN BOON MD UROLOGY
Entity Type:Organization
Organization Name:JOHN BOON MD UROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:REYNOLDS
Authorized Official - Last Name:BOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-565-1250
Mailing Address - Street 1:16651 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2345
Mailing Address - Country:US
Mailing Address - Phone:281-565-1250
Mailing Address - Fax:281-565-1255
Practice Address - Street 1:16651 SOUTHWEST FWY
Practice Address - Street 2:SUITE 310
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2345
Practice Address - Country:US
Practice Address - Phone:281-565-1250
Practice Address - Fax:281-565-1255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-29
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2957208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L16317Medicare PIN