Individual
BLAKE A BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1308 BELK BLVD, OXFORD, MS 38655-5302
(662) 234-6551
(662) 234-0468
Mailing address
1308 BELK BLVD, OXFORD, MS 38655-5302
(662) 234-6551
(662) 234-0468
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
21490
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000574
—
LA
Enumeration date
07/25/2007
Last updated
08/08/2011
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