Booth, Blake A
Booth, Blake A is an individual health care provider with primary practice located at 1308 Belk Blvd , Oxford MS 38655-5302. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Booth, Blake A can be contacted via phone (662) 234-6551.Contact Information
Primary practice address
1308 Belk Blvd
Oxford MS 38655-5302
Phone: (662) 234-6551
Fax: (662) 234-0468
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | 21490 | Mississippi |
Profile Details
| NPI number | 1194915249 |
|---|---|
| LBN Legal business name | Booth, Blake A |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 25th, 2007 |
| Last updated | Aug 8th, 2011 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1194915249 | NPPES |
| Louisiana | MEDICAID | 1000574 |
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