Basic Information
| Provider Information | |||||||||
| NPI: | 1639181076 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAMES J BOOKER IV MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 24506 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336234506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278232188 | ||||||||
| FaxNumber: | 7278239502 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 AVENUE K SE | ||||||||
| Address2: | STE 2 | ||||||||
| City: | WINTER HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338804146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8632991107 | ||||||||
| FaxNumber: | 8632913318 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 02/26/2009 | ||||||||
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| AuthorizedOfficialLastName: | BOOKER | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER / PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 8636766088 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | IV | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 271245801 | 01 | FL | MEDICAID - WINTERHAVEN | OTHER | DD5266 | 01 | RAILROAD MEDICARE | OTHER |