Provider Demographics
NPI:1225010952
Name:BOOTHBY, LUIS T (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:T
Last Name:BOOTHBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:DE DIEGO 14 E
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-832-4416
Mailing Address - Fax:787-832-4416
Practice Address - Street 1:DE DIEGO 14 E
Practice Address - Street 2:SUITE 103
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-832-4416
Practice Address - Fax:787-832-4416
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2012-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR5831208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics