Provider Demographics
NPI:1255406179
Name:BOONE, JEFFERY EUGENE (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:EUGENE
Last Name:BOONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 N 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060
Mailing Address - Country:US
Mailing Address - Phone:317-770-1057
Mailing Address - Fax:317-770-1044
Practice Address - Street 1:1049 N 10TH STREET
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060
Practice Address - Country:US
Practice Address - Phone:317-770-1057
Practice Address - Fax:317-770-1044
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0.2000717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INC24819Medicare UPIN
IN312280Medicare ID - Type Unspecified