Individual
DR. KENNETH EDWIN BOOTH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 221-8411
Mailing address
10006 WINDING RIDGE DR, SHREVEPORT, LA 71106-7684
(318) 798-1254
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD.015537
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1332968
—
LA
Enumeration date
08/08/2006
Last updated
07/08/2007
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