Provider Demographics
NPI:1225241094
Name:DAVID T BOOHER MD AMPC
Entity Type:Organization
Organization Name:DAVID T BOOHER MD AMPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BOOHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-988-2004
Mailing Address - Street 1:4212 W CONGRESS ST
Mailing Address - Street 2:SUITE 3600
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6765
Mailing Address - Country:US
Mailing Address - Phone:337-988-2004
Mailing Address - Fax:337-981-5012
Practice Address - Street 1:4212 W CONGRESS ST
Practice Address - Street 2:SUITE 3600
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6765
Practice Address - Country:US
Practice Address - Phone:337-988-2004
Practice Address - Fax:337-981-5012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12392R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1489140Medicaid
LA1489140Medicaid
LAH46511Medicare UPIN