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General NPI Number Information
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NPI Number | 1902063209
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Entity Type | Individual
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Provider Name | KERI LEIGH BURNS BOOTH MD
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Gender | Female
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 03/14/2013
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Provider Practice Location Address
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Address Line | 201 CEDAR ST SE SUITE 306
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City | ALBUQUERQUE
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State | NM
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Zip | 87106
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Country | US
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Telephone | 505-563-1010
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Fax | 505-563-1000
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Provider Business Mailing Address
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Address Line | 5800 MARIOLA PL NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-2362
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Country | US
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Telephone | 704-384-7840
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Fax | 704-384-7830
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | CS00218452
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License Number State | NM
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