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NPI Code Detail

MEDICARE: JASON BOOTH MD

MEDICARE:   JASON  BOOTH  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
1207Q00000XFamily Medicine Physician33657IA

Other Identifiers

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

General Provider Information

NPI Number : 1861460495
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON BOOTH MD
Provider Business Mailing Address
First Line : PO BOX 1824
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52406-1824
Country : US
Telephone Number : 319-369-4505
Fax Number : 319-369-4677
Provider Business Practice Location Address
First Line : 3933 MOUNT VERNON RD SE
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52403-3869
Country : US
Telephone Number : 319-363-8148
Fax Number : 319-363-9118
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2006
Last Update Date : 10/25/2007

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Directions to “ JASON BOOTH MD” Practice Location

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