Provider Demographics
NPI:1679646046
Name:BOONE, NORRIS IVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NORRIS
Middle Name:IVAN
Last Name:BOONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3600 SANDY FLAT RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-6216
Mailing Address - Country:US
Mailing Address - Phone:864-354-7415
Mailing Address - Fax:834-834-8581
Practice Address - Street 1:3600 SANDY FLAT RD
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-6216
Practice Address - Country:US
Practice Address - Phone:864-354-7415
Practice Address - Fax:834-834-8581
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC6584207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCB91567Medicare UPIN