Provider Demographics
NPI:1609035781
Name:BOONE, JOHN LUTHER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LUTHER
Last Name:BOONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14020 HWY 13 S STE 350
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-7103
Mailing Address - Country:US
Mailing Address - Phone:952-395-2500
Mailing Address - Fax:
Practice Address - Street 1:14020 HWY 13 S STE 350
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-7103
Practice Address - Country:US
Practice Address - Phone:952-395-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN56270207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1609035781Medicaid
MN1609035781Medicare NSC