Provider Demographics
NPI:1336229632
Name:JAMES E BOONE MD PLLC
Entity Type:Organization
Organization Name:JAMES E BOONE MD PLLC
Other - Org Name:JAMES E BOONE MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EARLE
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-761-1850
Mailing Address - Street 1:5575 POPLAR AVE
Mailing Address - Street 2:STE 504
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119
Mailing Address - Country:US
Mailing Address - Phone:901-761-1850
Mailing Address - Fax:901-761-1822
Practice Address - Street 1:5575 POPLAR AVE
Practice Address - Street 2:STE 504
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119
Practice Address - Country:US
Practice Address - Phone:901-761-1850
Practice Address - Fax:901-761-1822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3175345Medicaid
B03690Medicare UPIN
TN3175345Medicaid