Provider Demographics
NPI:1992754006
Name:BOONE, JAMES W (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:BOONE
Suffix:
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 1:916 DUPONT RD
Mailing Address - Street 2:
Mailing Address - City:LOU
Mailing Address - State:KY
Mailing Address - Zip Code:40207
Mailing Address - Country:US
Mailing Address - Phone:502-454-7107
Mailing Address - Fax:502-454-0347
Practice Address - Street 1:916 DUPONT RD
Practice Address - Street 2:
Practice Address - City:LOU
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-454-7107
Practice Address - Fax:502-454-0347
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY272082080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100327600Medicaid
KY64272081Medicaid