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General NPI Number Information
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NPI Number | 1255310710
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Entity Type | Individual
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Provider Name | DEREK V BOOTON MD
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Gender | Male
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Dates
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Enumeration Date | 01/12/2006
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Last Update Date | 11/29/2018
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Provider Practice Location Address
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Address Line | 110 29TH AVE N STE 202
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City | NASHVILLE
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State | TN
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Zip | 37203-1448
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Country | US
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Telephone | 615-327-4304
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Fax | 615-327-7940
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Provider Business Mailing Address
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Address Line | PO BOX 17037
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City | URBANA
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State | IL
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Zip | 61803-7037
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Country | US
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Telephone | 800-897-6169
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Fax | 800-897-6170
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 58170
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036102911
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License Number State | IL
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