Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 55760 | TN |
NPI | 1023306057 |
---|---|
Provider Name | Dr. Colin Douglas Booth |
First Address | Knoxville, TN 37923-4505 |
Second Address | Knoxville, TN 37923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2011 |
Last Update Date | 29/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q029240 | (05) | TN |