Basic Information
| Provider Information | |||||||||
| NPI: | 1659762425 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOONE | ||||||||
| FirstName: | ADDIE | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 909 SCENIC HILL DR APT 824 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761111298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063937574 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1310 SOUTHERN AVE SE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200324623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027412911 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2015 | ||||||||
| LastUpdateDate: | 05/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | S9269 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | MD210002286 | DC | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | S9269 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.