Individual
DR. KELEY JOHN BOOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4401 S WESTERN AVE, OKLAHOMA CITY, OK 73109-3413
(918) 664-9892
(918) 664-2521
Mailing address
PO BOX 6491, NORMAN, OK 73070-6491
(405) 947-8585
(405) 948-6507
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
22940
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200087480A
—
OK
01
—
433243ZPYY
MEDICARE
TX
Enumeration date
07/14/2006
Last updated
12/07/2015
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