Individual
ETHAN BOOTHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
815 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2224
(817) 321-0404
Mailing address
816 W CANNON ST, FORT WORTH, TX 76104-3146
(173) 210-9378
(504) 842-7806
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
Q2741
TX
Other
Enumeration date
04/10/2013
Last updated
07/30/2025
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