Provider Demographics
NPI:1144326364
Name:BOOTH, ADA (MD)
Entity type:Individual
Prefix:
First Name:ADA
Middle Name:
Last Name:BOOTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3533 S ALAMEDA ST
Mailing Address - Street 2:DRISCOLL CHILDREN'S HOSPITAL
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1721
Mailing Address - Country:US
Mailing Address - Phone:361-694-2273
Mailing Address - Fax:361-808-2058
Practice Address - Street 1:3533 S ALAMEDA ST
Practice Address - Street 2:DRISCOLL CHILDREN'S HOSPITAL
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1721
Practice Address - Country:US
Practice Address - Phone:361-694-2273
Practice Address - Fax:361-808-2058
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.093974208000000X
MO2006017751208000000X
TXP03502080C0008X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080C0008XAllopathic & Osteopathic PhysiciansPediatricsChild Abuse Pediatrics