Provider Demographics
NPI:1518929124
Name:BOONE, RALPH M (DO)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:M
Last Name:BOONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 DUNN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-6330
Mailing Address - Country:US
Mailing Address - Phone:904-757-1998
Mailing Address - Fax:904-696-7462
Practice Address - Street 1:1215 DUNN AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-6330
Practice Address - Country:US
Practice Address - Phone:904-757-1998
Practice Address - Fax:904-696-7462
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS2986207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE93961Medicare UPIN
FL81738XMedicare ID - Type Unspecified