Provider Demographics
NPI:1912589177
Name:BOOTHE, KANDIS WRIGHT (MD, PHD)
Entity type:Individual
Prefix:
First Name:KANDIS
Middle Name:WRIGHT
Last Name:BOOTHE
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:KANDIS
Other - Middle Name:LAYNE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1501 N. CAMPBELL AVE. PO BOX 245040
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-5035
Mailing Address - Country:US
Mailing Address - Phone:520-626-6349
Mailing Address - Fax:
Practice Address - Street 1:1501 N. CAMPBELL AVE.
Practice Address - Street 2:RM 6336, PO BOX 245040
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-5040
Practice Address - Country:US
Practice Address - Phone:520-626-2761
Practice Address - Fax:520-626-6020
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR78560207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine