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General NPI Number Information
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NPI Number | 1982963591
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Entity Type | Individual
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Provider Name | GRANT A. BOOHER M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/16/2012
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Last Update Date | 05/07/2021
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Provider Practice Location Address
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Address Line | 1001 12TH AVE STE 168
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City | FORT WORTH
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State | TX
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Zip | 76104-3947
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Country | US
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Telephone | 682-337-7463
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Fax | 682-337-7464
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Provider Business Mailing Address
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Address Line | PO BOX 185
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City | FORT WORTH
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State | TX
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Zip | 76101-0185
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Country | US
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Telephone | 682-337-7463
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Fax | 817-878-5334
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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 | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | R3479
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License Number State | TX
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