Provider Demographics
NPI:1215938022
Name:BOOTH, CYNTHIA D (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:D
Last Name:BOOTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CYNTHIA
Other - Middle Name:D
Other - Last Name:BOOTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:120 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-5618
Mailing Address - Country:US
Mailing Address - Phone:928-474-9744
Mailing Address - Fax:928-474-9766
Practice Address - Street 1:120 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5618
Practice Address - Country:US
Practice Address - Phone:928-474-9744
Practice Address - Fax:928-474-9766
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ27365174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ483529-02Medicaid
AZ483529-02Medicaid
AZH01251Medicare UPIN