MEDICARE: DEVIN BOOTHE MD

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	207P00000X	Emergency Medicine Physician	41445	AZ

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

General Provider Information

NPI Number	:	1952558645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVIN BOOTHE MD

Provider Business Mailing Address
First Line	:	465 SOUTH ST STE 103
Second Line	:
City	:	MORRISTOWN
State	:	NJ
Zip	:	07960-6442
Country	:	US
Telephone Number	:	844-362-1735
Fax Number	:	973-290-7495

Provider Business Practice Location Address
First Line	:	376 LAFAYETTE RD STE 101
Second Line	:
City	:	SPARTA
State	:	NJ
Zip	:	07871-3560
Country	:	US
Telephone Number	:	973-383-9898
Fax Number	:	973-300-3323

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

Provider Enumeration Date	:	08/25/2008
Last Update Date	:	03/20/2024

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