Individual
BRUCE W BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1051 LOFTIS BLVD, SUITE 100, NEWPORT NEWS, VA 23606-3069
(757) 873-9400
(757) 873-9420
Mailing address
5900 LAKE WRIGHT DR, SUITE 300, NORFOLK, VA 23502-1871
(757) 213-5700
(757) 213-5701
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
0101021044
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006068138
—
VA
01
—
110054751
RAILROAD MEDICARE
VA
01
—
55199
OPTIMA
VA
Enumeration date
06/17/2005
Last updated
09/22/2014
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