Provider Demographics
NPI:1871565366
Name:BOOTH, JOHN PRICE (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PRICE
Last Name:BOOTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 S DARGAN ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2549
Mailing Address - Country:US
Mailing Address - Phone:843-679-4260
Mailing Address - Fax:843-676-4264
Practice Address - Street 1:523 S DARGAN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2549
Practice Address - Country:US
Practice Address - Phone:843-679-4260
Practice Address - Fax:843-676-4264
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11079207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC110793Medicaid
SCC68968Medicare UPIN
SCC689688093Medicare UPIN