Provider Demographics
NPI:1598907537
Name:BOONE, JOSHUA JOHNSON (DPM)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JOHNSON
Last Name:BOONE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 K-96 HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530
Mailing Address - Country:US
Mailing Address - Phone:620-792-4383
Mailing Address - Fax:620-792-2058
Practice Address - Street 1:1514 K-96 HIGHWAY
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530
Practice Address - Country:US
Practice Address - Phone:620-792-4383
Practice Address - Fax:620-792-2058
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00428213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201143070AMedicaid
OR218103Medicaid
ORR164690Medicare PIN