Booth, Edgar

Booth, Edgar is an sole proprietor health care provider with primary practice located at 3725 W 4100 S Ste 102, West Valley City UT 84120-5417. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Booth, Edgar can be contacted via phone (801) 652-4466.

Contact Information

Primary practice address
3725 W 4100 S Ste 102 West Valley City UT 84120-5417
Phone: (801) 652-4466
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 1789851205 Utah

Profile Details

NPI number 1710985726
LBN Legal business name Booth, Edgar
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 13th, 2005
Last updated Mar 6th, 2019 - about 5 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710985726 NPPES
Utah MEDICAID D0432
Utah MEDICAID 805426200
Utah MEDICAID 114168600

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