Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | ME0044406 | FL |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | ME44406 | FL |
NPI | 1215023023 |
---|---|
Provider Name | Dr. Rene A Boothby |
First Address | Tampa, FL 33619-8327 |
Second Address | Tampa, FL 33603-1405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 03/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036277800 | (05) | FL |
D56646 | (02) | FL |