Provider Demographics
NPI:1740402007
Name:BOOKER, CORENTHIAN JEROME (MD)
Entity Type:Individual
Prefix:
First Name:CORENTHIAN
Middle Name:JEROME
Last Name:BOOKER
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 1:9440 E IRONWOOD SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4569
Mailing Address - Country:US
Mailing Address - Phone:480-756-0000
Mailing Address - Fax:855-636-8770
Practice Address - Street 1:9440 E IRONWOOD SQUARE DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4569
Practice Address - Country:US
Practice Address - Phone:480-756-6000
Practice Address - Fax:855-636-8770
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-00624207VM0101X
NC2012-01926207VM0101X
AZ58569207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ552544Medicaid