Booth, Marilyn J

Booth, Marilyn J is an sole proprietor health care provider with primary practice located at 3305 19Th Ave , Forest Grove OR 97116-1909. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Obstetrics. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Booth, Marilyn J can be contacted via phone (503) 357-7194.

Contact Information

Primary practice address
3305 19Th Ave Forest Grove OR 97116-1909
Phone: (503) 357-7194
Fax: (503) 357-5735
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD13329 Oregon
Allopathic & Osteopathic Physicians / Obstetrics 207VX0000X MD13329 Oregon

Profile Details

NPI number 1225057011
LBN Legal business name Booth, Marilyn J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 19th, 2006
Last updated Feb 11th, 2013 - about 12 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 1225057011 NPPES
Oregon Other 020711000 BC
Oregon MEDICAID 26676-7 BC

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