Provider Demographics
NPI:1386652733
Name:BOOTH, DAVID C (MD)
Entity Type:Individual
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First Name:DAVID
Middle Name:C
Last Name:BOOTH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:GILL HEART INSTITUTE 900 SOUTH LIMESTONE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0200
Mailing Address - Country:US
Mailing Address - Phone:859-323-3976
Mailing Address - Fax:859-257-6060
Practice Address - Street 1:GILL HEART INSTITUTE 800 ROSE ST
Practice Address - Street 2:G100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0093
Practice Address - Country:US
Practice Address - Phone:859-323-0295
Practice Address - Fax:859-257-8699
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2015-11-20
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Provider Licenses
StateLicense IDTaxonomies
KY21749207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64217490Medicaid
C65668Medicare UPIN
KY64217490Medicaid