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General NPI Number Information
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NPI Number | 1265810261
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Entity Type | Organization
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Legal Business Name | WILLIAM DAVID BOOTHE MD PA
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Dates
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Enumeration Date | 05/11/2015
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Last Update Date | 05/11/2015
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Provider Practice Location Address
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Address Line | 4020 21ST ST STE 3
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City | LUBBOCK
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State | TX
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Zip | 79410-1126
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Country | US
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Telephone | 806-797-6697
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Fax | 806-797-6849
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Provider Business Mailing Address
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Address Line | 4020 21ST ST STE 3
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City | LUBBOCK
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State | TX
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Zip | 79410-1126
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Country | US
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Telephone | 806-797-6697
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Fax | 806-797-6849
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LUANN BOOTHE
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Credential |
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Telephone | 806-797-6697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | F3769
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License Number State | TX
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