Individual
MICHAEL BOOKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2647 NE 33RD AVE, PORTLAND, OR 97212-3647
(503) 288-0083
(503) 288-7843
Mailing address
2647 NE 33RD AVE, PORTLAND, OR 97212-3647
(503) 288-0083
(503) 288-7843
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD16133
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
028907
—
OR
01
—
048194011
BLUE CROSS BLUE SHIELD
OR
Enumeration date
08/01/2006
Last updated
12/18/2007
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