Provider Demographics
NPI:1437320272
Name:CYNTHIA D. BOOTH, MD PLLC
Entity Type:Organization
Organization Name:CYNTHIA D. BOOTH, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-474-9744
Mailing Address - Street 1:120 E MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-5618
Mailing Address - Country:US
Mailing Address - Phone:928-474-9744
Mailing Address - Fax:928-474-9766
Practice Address - Street 1:120 E MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5618
Practice Address - Country:US
Practice Address - Phone:928-474-9744
Practice Address - Fax:928-474-9766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27365174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH01251Medicare UPIN