Individual
MARK W BOOKOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4151 RINGGOLD RD, EAST RIDGE, TN 37412-2434
(423) 622-5165
(423) 622-5167
Mailing address
6918 SHALLOWFORD RD, SUITE 206, CHATTANOOGA, TN 37421-6784
(423) 855-2552
(423) 855-9041
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
011511
TN
207Y00000X
Otolaryngology Physician
025947
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000282125B
—
GA
05
—
3021453
—
TN
Enumeration date
10/07/2005
Last updated
12/10/2012
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