Individual provider · NPI-1

Dr. Michael Booth, MD

Family Medicine · Grand Prairie, TX

NPI number1184073629
StatusActive
Last updated in NPPESApr 10, 2024

Details

NPI
1184073629
Entity type
Individual (NPI-1)
Name
Dr. Michael Booth
Credential
MD
Sex
Male
Sole proprietor
Yes
Enumeration date
Jun 6, 2016
Certification date
Apr 10, 2024
Last updated
Apr 10, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicines3124TXYes

Practice location

2520 W I 20
Grand Prairie, TX 75052-7280

Phone 722-645-8589 · Fax 972-264-8800

Mailing address

2520 W I 20
Grand Prairie, TX 75052-7280

Phone 972-264-5858 · Fax 972-264-8800

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