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Individual

RAYMOND BOOTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
11133 DUNN RD, SAINT LOUIS, MO 63136-6119
(314) 923-4640
(314) 653-4131
Mailing address
PO BOX 1125, MARYLAND HEIGHTS, MO 63043-0125
(888) 731-1036
(423) 892-5838

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
081391
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
203133
BCBS MO
MO
05
918546110
MO
01
P00273601
RR MEDICARE
MO
Enumeration date
05/27/2006
Last updated
05/23/2008
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