MEDICARE: DR. JOHN PARKS BOOKER M, D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085B0100X	Body Imaging Physician	18442	NC
2	2085N0700X	Neuroradiology Physician	18442	NC
3	2085N0904X	Nuclear Radiology Physician	18442	NC
4	2085P0229X	Pediatric Radiology Physician	18442	NC
5	2085R0202X	Diagnostic Radiology Physician	18442	NC
6	2085R0203X	Therapeutic Radiology Physician	18442	NC
7	2085R0204X	Vascular & Interventional Radiology Physician	18442	NC
8	2085R0205X	Radiological Physics Physician	18442	NC
9	2085U0001X	Diagnostic Ultrasound Physician	18442	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	300058518	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	16895	OTHER	NC	BCBS
4	560941927	OTHER	NC	CIGNA
5	560941927	OTHER	NC	MEDCOST
6	560941927	OTHER	NC	UNITED HEALTHCARE
7	246190	OTHER	NC	MAMSI

General Provider Information

NPI Number	:	1245215011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN PARKS BOOKER M, D.

Provider Business Mailing Address
First Line	:	PO BOX 308
Second Line	:	18 13TH AVE NE
City	:	HICKORY
State	:	NC
Zip	:	28603-0308
Country	:	US
Telephone Number	:	828-322-2644
Fax Number	:	828-327-2235

Provider Business Practice Location Address
First Line	:	18 13TH AVE NE
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28601-3748
Country	:	US
Telephone Number	:	828-322-2644
Fax Number	:	828-327-2235

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	10/26/2009

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