Provider Demographics
NPI:1629019237
Name:BOONE, SEAN D (DO)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:D
Last Name:BOONE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SEAN
Other - Middle Name:D
Other - Last Name:DAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:211 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-3821
Mailing Address - Country:US
Mailing Address - Phone:580-326-6111
Mailing Address - Fax:580-326-0469
Practice Address - Street 1:211 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-3821
Practice Address - Country:US
Practice Address - Phone:580-326-6111
Practice Address - Fax:580-326-0469
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100163220AMedicaid
OK100163220BMedicaid
OK100163220AMedicaid
OK100163220BMedicaid