Provider Demographics
NPI:1891028957
Name:BOOKOUT, ANGELA L (DO)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:L
Last Name:BOOKOUT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1733 W MAIN ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1321
Mailing Address - Country:US
Mailing Address - Phone:334-699-7546
Mailing Address - Fax:334-699-7548
Practice Address - Street 1:1733 W MAIN ST
Practice Address - Street 2:SUITE 500
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1321
Practice Address - Country:US
Practice Address - Phone:334-699-7546
Practice Address - Fax:334-699-7548
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA068485207N00000X, 207ND0101X
ALDO.1341207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology