Individual
MR. ROBERT DOUGLAS BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1265 UNION AVE, MEMPHIS, TN 38104-3415
(901) 516-7600
Mailing address
1698 PEACH AVE, MEMPHIS, TN 38112-5216
(901) 830-8826
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
127045
MT
363A00000X
Physician Assistant
Primary
1459
TN
363A00000X
Physician Assistant
1666
ME
363A00000X
Physician Assistant
399
AR
363A00000X
Physician Assistant
6889
AZ
363A00000X
Physician Assistant
PA04555
TX
363AM0700X
Medical Physician Assistant
PA00081
MS
363AM0700X
Medical Physician Assistant
PA04555
TX
363AM0700X
Medical Physician Assistant
PA1459
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0
—
TX
05
—
36650572
—
TN
Enumeration date
08/24/2006
Last updated
01/27/2025
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