Individual
RANDALL K BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3801 S NATIONAL AVE, SPRINGFIELD, MO 65807-5210
(417) 269-6000
Mailing address
1000 E PRIMROSE ST STE 520, SPRINGFIELD, MO 65807-5180
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
101471
MO
207LP2900X
Pain Medicine (Anesthesiology) Physician
101471
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100192010D
—
KS
05
—
207973231
—
MO
Enumeration date
03/21/2006
Last updated
03/17/2018
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