Individual
DR. MIRA BOONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1534 W D ST, NORTH WILKESBORO, NC 28659-3528
(336) 667-4178
(336) 667-0938
Mailing address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-5599
(336) 716-3202
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2008-00571
NC
207R00000X
Internal Medicine Physician
2008-00571
NC
208M00000X
Hospitalist Physician
Primary
2008-00571
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5909947
—
NC
Enumeration date
07/20/2007
Last updated
05/08/2018
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