Provider Demographics
NPI:1508001801
Name:BOONE, GEORGE ALAN (BC-HIS)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ALAN
Last Name:BOONE
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 S BAY ST
Mailing Address - Street 2:STE F
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6587
Mailing Address - Country:US
Mailing Address - Phone:352-483-4327
Mailing Address - Fax:352-483-4328
Practice Address - Street 1:2755 S BAY ST
Practice Address - Street 2:STE F
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6587
Practice Address - Country:US
Practice Address - Phone:352-483-4327
Practice Address - Fax:352-483-4328
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS3434237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3524834327Medicare NSC