Provider Demographics
NPI:1427158278
Name:BOONE, NUNTAVAN (MD)
Entity type:Individual
Prefix:
First Name:NUNTAVAN
Middle Name:
Last Name:BOONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 S HAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-5580
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7212 INDEPENDENCE PKWY
Practice Address - Street 2:PEDIATRICS AFTER HOURS
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-5761
Practice Address - Country:US
Practice Address - Phone:972-618-2493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2009-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5257208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics