Individual
CHARLES MOORE BOOTHBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3890 TAMPA RD, SUITE 201, PALM HARBOR, FL 34684-3676
(727) 781-3111
(727) 781-3113
Mailing address
PO BOX 25513, TAMPA, FL 33622-5513
(727) 823-2188
(727) 828-0723
Taxonomy
Speciality
Code
Description
License number
State
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
Primary
OS4598
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
069165800
—
FL
Enumeration date
06/22/2006
Last updated
03/29/2016
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