Individual
BOONE BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6201 HARRY HINES BLVD, DALLAS, TX 75390-0001
(214) 633-5555
Mailing address
PO BOX 845347, DALLAS, TX 75284-7208
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA14611
TX
Other
Enumeration date
05/26/2021
Last updated
05/26/2021
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