Individual
BRADLEY DAVID BOOTHE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
998 S DORSET RD, TROY, OH 45373-4753
(937) 440-7358
Mailing address
998 S DORSET RD, TROY, OH 45373-4753
(937) 440-7358
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APRN.CNP.022278
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0265013
—
OH
Enumeration date
02/08/2018
Last updated
05/16/2022
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