Organization
SOUTHEASTERN OHIO OTOLARYNGOLOGY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK B BOOTH M.D. (PRESIDENT)
(740) 455-6202
Entity
Organization
Contact information
Practice address
930 BETHESDA DR. BLDG 4, ZANESVILLE, OH 43701-0815
(740) 455-6202
Mailing address
930 BETHESDA DR. BLDG 4, ZANESVILLE, OH 43701-0815
(740) 455-6202
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0511619
—
OH
Enumeration date
05/03/2007
Last updated
01/09/2014
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