Provider Demographics
NPI:1275790297
Name:BOOHER, MICHAEL REID (AP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:REID
Last Name:BOOHER
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1954 HOWELL BRANCH RD.
Mailing Address - Street 2:SUITE 112
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792
Mailing Address - Country:US
Mailing Address - Phone:407-677-9993
Mailing Address - Fax:407-677-9902
Practice Address - Street 1:1954 HOWELL BRANCH RD
Practice Address - Street 2:SUITE 112
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-1041
Practice Address - Country:US
Practice Address - Phone:407-677-9993
Practice Address - Fax:407-677-9902
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 536171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist