Individual
EDGAR ALAN BOONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 WEST HOSPITAL DRIVE, WHITERIVER, AZ 85941-0860
(928) 338-4911
(928) 338-5508
Mailing address
P.O.BOX 860, WHITERIVER, AZ 85941-0860
(928) 338-4911
(928) 338-5508
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD027914E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000067334
HIGHMARK
PA
05
—
0010968930002
—
PA
01
—
010028191
PALMETTO GBA RR MEDICARE
PA
01
—
0473267
AETNA
PA
01
—
104152
UPMC HEALTH PLAN
PA
01
—
1409575
UNITED MINE WORKERS
PA
01
—
1427335140
WHITERIVER
—
01
—
1427335181
CBQ
—
Enumeration date
07/18/2005
Last updated
04/03/2012
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