Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | G77956 | CA |
NPI | 1104822832 |
---|---|
Provider Name | Kevin Charles Booth |
First Address | Danville, CA 94526-4022 |
Second Address | Pleasanton, CA 94588-4007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 14/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G66858 | (02) |