| Doctor Name: | JOHN P BOOTHE |
| NPI Number: | 1396875720 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | RPA-101 |
| Business Practice Address: | 486 West 1st Ave Glenns Ferry, ID - 83623 |
| Business Phone Number: | 2083667416 |
| Business Fax Number: | 2083662595 |
| Mailing Address: | Po Box 266, GLENNS FERRY |
| State: | ID |
| Postal Code: | 836230266 |
| Phone Number: | 2083667416 |
| Fax Number: | 2083662595 |
| NPI Enumeration Date: | 03/06/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | RPA-101 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |