Provider Demographics
NPI:1639448152
Name:BOOKIN, JEROME I (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:I
Last Name:BOOKIN
Suffix:
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 1:3108 STEVENSON DR
Mailing Address - Street 2:
Mailing Address - City:PEBBLE BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93953-2834
Mailing Address - Country:US
Mailing Address - Phone:831-375-3380
Mailing Address - Fax:
Practice Address - Street 1:3108 STEVENSON DR
Practice Address - Street 2:
Practice Address - City:PEBBLE BEACH
Practice Address - State:CA
Practice Address - Zip Code:93953-2834
Practice Address - Country:US
Practice Address - Phone:831-375-3380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGFE131472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology