Basic Information
| Provider Information | |||||||||
| NPI: | 1528119898 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOONE | ||||||||
| FirstName: | CORBETT | ||||||||
| MiddleName: | HOWARD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 848491 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752848491 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 140 HILLCREST MEDICAL BLVD STE 2 | ||||||||
| Address2: | |||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767128897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547411400 | ||||||||
| FaxNumber: | 2547411428 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2007 | ||||||||
| LastUpdateDate: | 12/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | M5642 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207P00000X | M5642 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | M5642 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.