Individual
JACK BRANYON BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
35-036061
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0274206
—
OH
Enumeration date
12/12/2006
Last updated
01/08/2014
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