Individual
DR. GREGORY RICHARD BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
621 S NEW BALLAS RD STE 2016B, SAINT LOUIS, MO 63141-8265
(143) 251-5860
(314) 251-5861
Mailing address
1465 S GRAND BLVD, SAINT LOUIS, MO 63104-1003
(314) 268-4101
(314) 577-5379
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
2002001984
MO
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
2002001984
MO
Other
Enumeration date
05/28/2007
Last updated
02/13/2020
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