Provider Demographics
NPI:1629034822
Name:BOONE, ELWOOD BERNARD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ELWOOD
Middle Name:BERNARD
Last Name:BOONE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:110 N ROBINSON ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220
Mailing Address - Country:US
Mailing Address - Phone:804-354-6202
Mailing Address - Fax:804-354-0870
Practice Address - Street 1:110 N ROBINSON ST
Practice Address - Street 2:SUITE 403
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220
Practice Address - Country:US
Practice Address - Phone:804-354-6202
Practice Address - Fax:804-354-0870
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2008-08-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101020738208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1629034822Medicaid
VA7556870Medicaid
342930208Medicare PIN
B06483Medicare UPIN
VA7556870Medicaid
P00607194Medicare PIN