Provider Demographics
NPI:1023279486
Name:BOOTH, DENEENE RAPHAELLE (MD)
Entity type:Individual
Prefix:MS
First Name:DENEENE
Middle Name:RAPHAELLE
Last Name:BOOTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:DENEENE
Other - Middle Name:RAPHAELLE
Other - Last Name:DOYKER-BOOTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1021 W OAKLAND AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2192
Mailing Address - Country:US
Mailing Address - Phone:423-302-6567
Mailing Address - Fax:
Practice Address - Street 1:601 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-9700
Practice Address - Country:US
Practice Address - Phone:276-258-1670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA253847207LP2900X
CT051193207LP2900X
VA0101267592207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine