Provider Demographics
NPI:1841215126
Name:BOONE, KAREN ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ELIZABETH
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 1:4790 EXECUTIVE CENTRE PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1606
Mailing Address - Country:US
Mailing Address - Phone:636-441-3100
Mailing Address - Fax:636-441-6784
Practice Address - Street 1:4790 EXECUTIVE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1606
Practice Address - Country:US
Practice Address - Phone:636-441-3100
Practice Address - Fax:636-441-6784
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO101899207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG36773Medicare UPIN
MO003013490Medicare ID - Type Unspecified