Individual
DR. SALLY A BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
12050 N MICHIGAN RD, ZIONSVILLE, IN 46077-8782
(317) 848-2427
(317) 848-2434
Mailing address
12050 N MICHIGAN RD, ZIONSVILLE, IN 46077-8782
(317) 848-2427
(317) 848-2434
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
01042816A
IN
207N00000X
Dermatology Physician
ME142799
FL
207ND0101X
MOHS-Micrographic Surgery Physician
01042816A
IN
207NS0135X
Procedural Dermatology Physician
01042816A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000375169
ANTHEM PIN
IN
Enumeration date
01/23/2006
Last updated
01/26/2021
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