Provider Demographics
NPI:1124126297
Name:BOONE, ROY H JR (MD)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:H
Last Name:BOONE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 39181
Mailing Address - Street 2:
Mailing Address - City:NINILCHIK
Mailing Address - State:AK
Mailing Address - Zip Code:99639
Mailing Address - Country:US
Mailing Address - Phone:907-567-4354
Mailing Address - Fax:
Practice Address - Street 1:805 FRONTAGE RD SUITE 130
Practice Address - Street 2:US DEPARTMENT OF VETERANS AFFAIRS
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611
Practice Address - Country:US
Practice Address - Phone:907-283-2231
Practice Address - Fax:907-283-4236
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK5186207R00000X
FLME54837207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B63662Medicare UPIN