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WILLIE BENTON BOONE M.D.

>> Ophthalmology >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1942236542

Individual Registrant:
 WILLIE BENTON BOONE M.D.
Gender: M
Sole Proprietor

Location and contact information for practice:
25 TRAMONTO DR  RANCHO PALOS VERDES, CA 90275-5387 US
Tel: 310-265-9313  Fax: 310-265-8434

Contact information for business:
25 TRAMONTO DR  RANCHO PALOS VERDES, CA 90275-5387 US
Tel: 310-265-9313  Fax: 310-265-8434

Registration Information:
NPI: 1942236542
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207W00000XAllopathic & Osteopathic Physicians
Ophthalmology
CAG13745

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
CA LICENSEG13745CA01
INDIVIDUAL PROVIDER TRANSACTION ACCESS NUMBER (PTAN)WG13745CCA01
00G137450CA05




HEALTH CARE JOBS CA - Page 1



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