MEDICARE: ZOEB BOOTWALA MD

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	207R00000X	Internal Medicine Physician	71098	GA

General Provider Information

NPI Number	:	1457587123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZOEB BOOTWALA MD

Provider Business Mailing Address
First Line	:	PO BOX 5048
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31208-5048
Country	:	US
Telephone Number	:	478-918-0770
Fax Number	:	478-918-0771

Provider Business Practice Location Address
First Line	:	1531 WATSON BLVD
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31093-3449
Country	:	US
Telephone Number	:	478-599-0110
Fax Number	:	478-599-0001

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

Provider Enumeration Date	:	06/08/2009
Last Update Date	:	03/06/2015

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Directions to “ ZOEB BOOTWALA MD” Practice Location

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