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General NPI Number Information
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NPI Number | 1548377518
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Entity Type | Individual
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Provider Name | ROBERT DOUGLAS BOOTH PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 1265 UNION AVE
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City | MEMPHIS
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State | TN
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Zip | 38104-3415
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Country | US
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Telephone | 901-516-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 1698 PEACH AVE
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City | MEMPHIS
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State | TN
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Zip | 38112-5216
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Country | US
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Telephone | 901-830-8826
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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 | 127045
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 6889
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1666
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License Number State | ME
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 399
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License Number State | AR
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Taxonomy #5
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA04555
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License Number State | TX
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Taxonomy #6
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA1459
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License Number State | TN
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Taxonomy #7
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA04555
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License Number State | TX
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Taxonomy #8
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA00081
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License Number State | MS
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Taxonomy #9
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1459
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License Number State | TN
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