Individual
MR. LAWRENCE BOONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSA
Contact information
Practice address
1401 N 10TH AVE, STAYTON, OR 97383-1311
(503) 769-9314
Mailing address
2844 HOOVER AVE NW, SALEM, OR 97304-3789
(410) 733-2209
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
1315
AZ
Other
Enumeration date
04/28/2020
Last updated
04/28/2020
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