Individual
MR. WILLIAM J BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
540 LINCOLN PARK BLVD. SUITE 390, KETTERING, OH 45429
(937) 296-1128
(937) 296-1728
Mailing address
540 LINCOLN PARK BLVD. SUITE 390, KETTERING, OH 45429
(937) 296-1128
(937) 296-1728
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
50.000525
OH
363AM0700X
Medical Physician Assistant
Primary
50.000525RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0109017
—
OH
01
—
50.000525
PA LICENSE
OH
Enumeration date
10/16/2008
Last updated
03/05/2025
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