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General NPI Number Information
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NPI Number | 1245278027
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Entity Type | Individual
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Provider Name | THOMAS EDWARD BOOTH MD
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Gender | Male
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 2001 WINWARD WAY STE 101
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City | SAN MATEO
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State | CA
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Zip | 94404-2499
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Country | US
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Telephone | 650-288-0596
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Fax |
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Provider Business Mailing Address
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Address Line | 308 CAPSTAN CT
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City | REDWOOD CITY
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State | CA
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Zip | 94065-1024
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Country | US
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Telephone | 650-868-2846
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G69034
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License Number State | CA
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