Provider Demographics
NPI:1528016235
Name:BOONE, ANDREA B (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:B
Last Name:BOONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 S COURT ST
Mailing Address - Street 2:STE B
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-4931
Mailing Address - Country:US
Mailing Address - Phone:559-741-1202
Mailing Address - Fax:559-741-0123
Practice Address - Street 1:1700 S COURT ST STE B
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4931
Practice Address - Country:US
Practice Address - Phone:559-741-1202
Practice Address - Fax:559-741-0123
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79417207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0067850Medicaid
CAZZZ47930ZMedicare ID - Type UnspecifiedMEDICARE
CAG29471Medicare UPIN