Provider Demographics
NPI:1447216411
Name:BOOKER, SCOTT D (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:D
Last Name:BOOKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 N MAIN ST
Mailing Address - Street 2:P O BOX 1133
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-5400
Mailing Address - Country:US
Mailing Address - Phone:620-276-8201
Mailing Address - Fax:620-275-0712
Practice Address - Street 1:911 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5400
Practice Address - Country:US
Practice Address - Phone:620-276-8201
Practice Address - Fax:620-275-0712
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-23465207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100088530BMedicaid
KS040927Medicare ID - Type Unspecified
KS100088530BMedicaid