Provider Demographics
NPI:1205832425
Name:BOOTHE, WILLIAM DAVID (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DAVID
Last Name:BOOTHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12210 QUAKER AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-1197
Mailing Address - Country:US
Mailing Address - Phone:806-792-5900
Mailing Address - Fax:806-792-6092
Practice Address - Street 1:12210 QUAKER AVE
Practice Address - Street 2:STE 3
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-7942
Practice Address - Country:US
Practice Address - Phone:806-792-5900
Practice Address - Fax:806-792-6092
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3769207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122946003Medicaid
TX00DY05Medicare PIN
TX122946003Medicaid