MEDICARE: DAVID G BOOTH DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	13719	MS
2	207Q00000X	Family Medicine Physician	2014-00095	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093788523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID G BOOTH DO

Provider Business Mailing Address
First Line	:	1301 VETERANS MEMORIAL BLVD
Second Line	:
City	:	EUPORA
State	:	MS
Zip	:	39744-2064
Country	:	US
Telephone Number	:	662-258-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 VETERANS MEMORIAL BLVD
Second Line	:
City	:	EUPORA
State	:	MS
Zip	:	39744-2064
Country	:	US
Telephone Number	:	662-258-7200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	09/15/2016

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Directions to “ DAVID G BOOTH DO” Practice Location

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