Provider Demographics
NPI:1639181076
Name:JAMES J BOOKER IV MD PA
Entity Type:Organization
Organization Name:JAMES J BOOKER IV MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOOKER
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:863-676-6088
Mailing Address - Street 1:PO BOX 24506
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33623-4506
Mailing Address - Country:US
Mailing Address - Phone:727-823-2188
Mailing Address - Fax:727-823-9502
Practice Address - Street 1:400 AVENUE K SE
Practice Address - Street 2:STE 2
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4146
Practice Address - Country:US
Practice Address - Phone:863-299-1107
Practice Address - Fax:863-291-3318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271245801OtherMEDICAID - WINTERHAVEN
DD5266OtherRAILROAD MEDICARE
FL271245801OtherMEDICAID - WINTERHAVEN
H62595Medicare UPIN