1710948385 NPI number — DR. WILLIAM ALBERT BOOTHE MD

Table of content: DR. WILLIAM ALBERT BOOTHE MD (NPI 1710948385)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710948385 NPI number — DR. WILLIAM ALBERT BOOTHE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOOTHE
Provider First Name:
WILLIAM
Provider Middle Name:
ALBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710948385
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5204 LINCOLNSHIRE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75287-5427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-867-3955
Provider Business Mailing Address Fax Number:
972-732-7542

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3900 W 15TH ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75075-7751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-867-3955
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  F9221 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 098016102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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