Provider Demographics
NPI:1710948385
Name:BOOTHE, WILLIAM ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALBERT
Last Name:BOOTHE
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 1:5204 LINCOLNSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-5427
Mailing Address - Country:US
Mailing Address - Phone:972-867-3955
Mailing Address - Fax:972-732-7542
Practice Address - Street 1:3900 W 15TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7751
Practice Address - Country:US
Practice Address - Phone:972-867-3955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9221207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098016102Medicaid
TXB21385Medicare UPIN
TXTXB100383Medicare PIN
TX00DP12Medicare PIN