Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | OS-002169-L | PA |
N | 208D00000X | General Practice Physician | OS-002169-L | PA |
NPI | 1710023650 |
---|---|
Provider Name | Dr. Thurman Davis Booker |
First Address | Eagleville, PA 19403-1829 |
Second Address | Eagleville, PA 19403-1829 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E63313 | (02) | PA |