Individual
DR. MICHAEL H BOOTHBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2901 ACME BRICK PLZ, FORT WORTH, TX 76109-4124
(817) 529-1900
(817) 529-1910
Mailing address
2901 ACME BRICK PLZ, FORT WORTH, TX 76109-4124
(817) 529-1900
(817) 529-1910
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
M1030
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182488002
—
TX
01
—
8V9720
BCBS INDIVIDUAL #
—
01
—
P01010705
MEDICARE RAILROAD
TX
Enumeration date
05/31/2006
Last updated
10/08/2020
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