Provider Demographics
NPI:1710023650
Name:BOOKER, THURMAN DAVIS (DO)
Entity Type:Individual
Prefix:DR
First Name:THURMAN
Middle Name:DAVIS
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 1:100 EAGLEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:EAGLEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19403-1829
Mailing Address - Country:US
Mailing Address - Phone:610-539-6000
Mailing Address - Fax:610-539-9314
Practice Address - Street 1:100 EAGLEVILLE RD
Practice Address - Street 2:
Practice Address - City:EAGLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19403-1829
Practice Address - Country:US
Practice Address - Phone:610-539-6000
Practice Address - Fax:610-539-9314
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-002169-L207QA0401X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE63313Medicare UPIN