Individual
EDGAR BOOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3725 W 4100 S, STE 102, WEST VALLEY CITY, UT 84120-5417
(801) 652-4466
Mailing address
PO BOX 1169, BOUNTIFUL, UT 84011-1169
(801) 296-2113
(801) 296-1715
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
1789851205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114168600
—
WY
05
—
805426200
—
ID
05
—
D0432
—
UT
Enumeration date
07/13/2005
Last updated
03/06/2019
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