Provider Demographics
NPI:1952342974
Name:BOONE, PAUL W JR (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:W
Last Name:BOONE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2940 W MARINE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3926
Mailing Address - Country:US
Mailing Address - Phone:425-258-7014
Mailing Address - Fax:425-258-7760
Practice Address - Street 1:14692 179TH AVE SE
Practice Address - Street 2:SUITE 500
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1198
Practice Address - Country:US
Practice Address - Phone:360-794-7994
Practice Address - Fax:360-805-4757
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00040105207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8425910Medicaid
F88895Medicare UPIN
WA8860616Medicare ID - Type Unspecified