Provider Demographics
NPI:1750843710
Name:BOONE, MEGUMI D (MD)
Entity Type:Individual
Prefix:
First Name:MEGUMI
Middle Name:D
Last Name:BOONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7283
Mailing Address - Country:US
Mailing Address - Phone:601-722-4300
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:215 BOBBY BEASLEY ST
Practice Address - Street 2:
Practice Address - City:SEMINARY
Practice Address - State:MS
Practice Address - Zip Code:39479-5501
Practice Address - Country:US
Practice Address - Phone:601-722-4300
Practice Address - Fax:601-579-5240
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS30435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine