Basic Information
| Provider Information | |||||||||
| NPI: | 1750335055 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BONE | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | MASON | ||||||||
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| Credential: | MD, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 E 14TH ST | ||||||||
| Address2: | |||||||||
| City: | SEDALIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 653015972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6608268833 | ||||||||
| FaxNumber: | 6608296611 | ||||||||
| Practice Location | |||||||||
| Address1: | 2846 WALLACE LAKE RD | ||||||||
| Address2: | |||||||||
| City: | PACE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509957273 | ||||||||
| FaxNumber: | 3472148207 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 06/26/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 30285 | AL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 37548 | KY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207PE0004X | 01049225A | IN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | 207Q00000X | ME 97720 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 37548 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 36565 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 10226 | 01 | MT | LICENSE | OTHER | 4776372-1205 | 01 | UT | LICENSE | OTHER | 65927196 | 05 | KY | MEDICAID | 30285 | 01 | AL | ALABAMA MEDICAL LICENSE | OTHER | 36565 | 01 | TN | LICENSE | OTHER | 45517 | 01 | MN | LICENSE | OTHER | 4784 | 01 | SD | SD MEDICAL LICENSE | OTHER | 8509 | 01 | ND | LICENSE | OTHER | 01049225C | 01 | IN | CONTROLLED SUBST. REGISTR | OTHER | ME 97720 | 01 | FL | FLORIDA MEDICAL LICESNE | OTHER | 4776372-8905 | 01 | UT | CONTROLLED SUBST REGISTR. | OTHER | 37548 | 01 | KY | LICENSE | OTHER | 01049225A | 01 | IN | LICENSE | OTHER | 2001007179 | 01 | MO | LICENSE | OTHER |