Provider Demographics
NPI:1770596157
Name:BOONE, PAUL (M D)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:BOONE
Suffix:
Gender:M
Credentials:M D
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Other - Credentials:
Mailing Address - Street 1:5050 CRENSHAW ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3139
Mailing Address - Country:US
Mailing Address - Phone:281-487-1000
Mailing Address - Fax:281-487-6158
Practice Address - Street 1:5050 CRENSHAW ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3139
Practice Address - Country:US
Practice Address - Phone:281-487-1000
Practice Address - Fax:281-487-6158
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2012-08-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXE8345207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE79392Medicare UPIN