Individual
BRADLEY A BOONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3201 S AUSTIN AVE, GEORGETOWN, TX 78626-7545
(512) 459-8753
(512) 483-6807
Mailing address
2111 14TH ST, MERIDIAN, MS 39301-4041
(601) 693-3834
(601) 484-3225
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
44117
OK
2086S0129X
Vascular Surgery Physician
Primary
P8338
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201292450A
—
OK
05
—
333764R401
—
TX
Enumeration date
02/06/2006
Last updated
10/29/2024
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