Provider Demographics
NPI:1255397824
Name:BOOTHE, JULIA LETT (MD)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:LETT
Last Name:BOOTHE
Suffix:
Gender:F
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:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:REFORM
Mailing Address - State:AL
Mailing Address - Zip Code:35481-1000
Mailing Address - Country:US
Mailing Address - Phone:205-337-5625
Mailing Address - Fax:205-375-9064
Practice Address - Street 1:108 4TH AVE SW
Practice Address - Street 2:
Practice Address - City:REFORM
Practice Address - State:AL
Practice Address - Zip Code:35481-8018
Practice Address - Country:US
Practice Address - Phone:205-375-6251
Practice Address - Fax:205-375-9064
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025469207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL163383Medicaid
ALH98239Medicare UPIN
AL102I087870Medicare PIN