Booth, Marilyn J
Booth, Marilyn J is an sole proprietor health care provider with primary practice located at 3305 19Th Ave , Forest Grove OR 97116-1909. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Obstetrics. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Booth, Marilyn J can be contacted via phone (503) 357-7194.Contact Information
Primary practice address
3305 19Th Ave
Forest Grove OR 97116-1909
Phone: (503) 357-7194
Fax: (503) 357-5735
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | MD13329 | Oregon |
| Allopathic & Osteopathic Physicians / Obstetrics | 207VX0000X | MD13329 | Oregon |
Profile Details
| NPI number | 1225057011 |
|---|---|
| LBN Legal business name | Booth, Marilyn J |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 19th, 2006 |
| Last updated | Feb 11th, 2013 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1225057011 | NPPES |
| Oregon | Other | 020711000 | BC |
| Oregon | MEDICAID | 26676-7 | BC |
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