Healthcare Provider Details

I. General information

NPI: 1528104791
Provider Name (Legal Business Name): ROBERT H. BOOKER AP/DOM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14022 5TH ST STE B
DADE CITY FL
33525-4323
US

IV. Provider business mailing address

5399 TOWER STREET
RIDGE MANOR FL
33523
US

V. Phone/Fax

Practice location:
  • Phone: 352-458-9234
  • Fax: 352-518-4627
Mailing address:
  • Phone: 352-458-9234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP738
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberSCOPE OF PRACTICE
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License NumberSCOPE OF PRACTICE
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: