Provider Demographics
NPI:1982651832
Name:BOONE, MARY NELL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:NELL
Last Name:BOONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:NELL
Other - Last Name:SUELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6701 FANNIN ST. SUITE 1400
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-504-3132
Mailing Address - Fax:832-825-1032
Practice Address - Street 1:6701 FANNIN ST. SUITE 1400
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-504-3132
Practice Address - Fax:832-825-1032
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2682208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165567203OtherCIDC
TX165567202Medicaid
TX8C9480Medicare PIN
TX165567203OtherCIDC