Provider Demographics
NPI:1205886538
Name:BOOTH, NORMAN S (PA-C)
Entity type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:S
Last Name:BOOTH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-4754
Mailing Address - Country:US
Mailing Address - Phone:507-287-0674
Mailing Address - Fax:
Practice Address - Street 1:2110 E CENTER ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-4754
Practice Address - Country:US
Practice Address - Phone:507-287-0674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8903363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical