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General NPI Number Information
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NPI Number | 1306721808
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Entity Type | Individual
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Provider Name | SAMPSON RAY BOOTH PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/06/2025
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 4311 OLD OCEAN HWY
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City | BOLIVIA
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State | NC
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Zip | 28422-8637
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Country | US
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Telephone | 877-935-5255
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Fax |
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Provider Business Mailing Address
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Address Line | 4105 RAMSEUR JULIAN RD
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City | LIBERTY
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State | NC
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Zip | 27298-8606
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Country | US
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Telephone | 336-588-4262
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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