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General NPI Number Information
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NPI Number | 1023306057
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Entity Type | Individual
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Provider Name | COLIN DOUGLAS BOOTH M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/11/2011
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 9430 PARK WEST BLVD STE 130
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City | KNOXVILLE
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State | TN
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Zip | 37923-4205
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Country | US
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Telephone | 865-690-4861
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Fax | 865-560-8525
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Provider Business Mailing Address
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Address Line | PO BOX 306556
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City | NASHVILLE
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State | TN
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Zip | 37230-6556
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Country | US
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Telephone | 865-694-0062
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Fax | 865-694-7907
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 55760
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License Number State | TN
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