Provider Demographics
NPI:1417917709
Name:BOOTHE, THOMAS E JR (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:BOOTHE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 S US HWY 75, SUITE 300
Mailing Address - Street 2:ATTN BILLING
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4587
Mailing Address - Country:US
Mailing Address - Phone:903-892-1005
Mailing Address - Fax:
Practice Address - Street 1:2907 OVERLAND TRL
Practice Address - Street 2:SUITE 200
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-4492
Practice Address - Country:US
Practice Address - Phone:903-892-1005
Practice Address - Fax:903-892-0704
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4215207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128688206Medicaid
OK100163920BMedicaid
TX329432YMCMMedicare PIN
TX128688206Medicaid