Provider Demographics
NPI:1407693419
Name:BOOKER, BOBBY JAMES
Entity type:Individual
Prefix:
First Name:BOBBY
Middle Name:JAMES
Last Name:BOOKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3034 PERCY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-7310
Mailing Address - Country:US
Mailing Address - Phone:513-390-5498
Mailing Address - Fax:
Practice Address - Street 1:3034 PERCY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-7310
Practice Address - Country:US
Practice Address - Phone:513-390-5498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN697305172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver