DR. JASON REDWOOD BOOLE (NPI# 1104818350) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104818350 |
| Entity Type | Individual |
| Full Name | DR. JASON REDWOOD BOOLE |
| Credential | M.D. |
| Practice Address |
310 Racetrack Rd Nw Ste 100 Fort Walton Beach FL 32547-1553 |
| Mailing Address |
310 Racetrack Rd Nw Fort Walton Beach FL 32547-1553 |
| Practice Telephone | 8508894550 |
| Practice Fax Number | 8508894549 |
| Mailing Telephone | 8508894550 |
| Mailing Fax Number | 8508075217 |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2019-04-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Y00000X | Otolaryngology | L9631 | TX | Allopathic & Osteopathic Physicians |
| Y | 207Y00000X | Otolaryngology | ME96773 | FL | Allopathic & Osteopathic Physicians |
| N | 207YX0602X |
Otolaryngology Specialization: Otolaryngic Allergy |
ME96773 | FL | Allopathic & Osteopathic Physicians |
| N | 207YS0012X |
Otolaryngology Specialization: Sleep Medicine |
L9631 | TX | Allopathic & Osteopathic Physicians |
| N | 207YS0012X |
Otolaryngology Specialization: Sleep Medicine |
ME96773 | FL | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3754 Highway 90 Ste 390a, Milton, FL 325711096 | 8504994198 | |
| 310 Racetrack Rd Nw, Fort Walton Beach, FL 325471553 | 8508894550 | 8508894549 |
| Street Address |
310 RACETRACK RD NW STE 100 |
| City | FORT WALTON BEACH |
| State | FL |
| Zip Code | 32547-1553 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659855567 | Matthew Wisniewski | Physical Therapist | 310 Racetrack Rd Nw Ste 100, Fort Walton Beach, FL 32547-1553 | 2018-09-18 |
| 1821466491 | Northwest Florida Ent Pa | Otolaryngology | 310 Racetrack Rd Nw Ste 100, Fort Walton Beach, FL 32547-1553 | 2015-09-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255944955 | Theresa Ann Morvay | Behavior Technician | 419 Racetrack Rd Ne, Fort Walton Beach, FL 32547 | 2020-08-24 |
| 1588295422 | Emily Ann Glossop | Nurse Practitioner | 930 Mar Walt Drive C, Fort Walton Beach, FL 32547 | 2020-01-29 |
| 1225669443 | Elizabeth Rogers Nagengast | Physician Assistant | 930 Mar Walt Drive, Unit C, Fort Walton Beach, FL 32547 | 2020-01-27 |
| 1497254791 | Carmen Alston | Nurse Practitioner | 930 Mar Walt Dr C, Fort Walton Beach, FL 32547 | 2018-02-02 |
| 1871004960 | Center for Neuropsychological Services Cns | Clinical Neuropsychologist | 1817 Lewis Turner Blvd, Fort Walton Beach, FL 32547 | 2017-10-17 |
| 1194235648 | Robin Wray | Speech-Language Pathologist | 930 Mar Walt Dr D, Fort Walton Beach, FL 32547 | 2017-10-10 |
| 1285007989 | Dynamic Pain & Wellness Pllc | Pain Medicine | 930 Marwalt Drive, Suite B and C, Fort Walton Beach, FL 32547 | 2015-11-04 |
| 1013392810 | Terry Abbott | Social Worker | 648 Overbrook Dr, Fort Walton Beach, FL 32547 | 2015-07-22 |
| 1083024673 | Emily Lohr | Physical Therapy Assistant | 2000 Principle Ln, Ft. Walton Beach, FL 32547 | 2014-05-05 |
| 1831526102 | Laurie Ann Schweppe | Nurse Practitioner | 1005 Mar Walt Drivve, Snf Hospitalist Department, Fort Walton Beach, FL 32547 | 2013-10-02 |
| Find all providers in zip 32547 | ||||
| Taxonomy Code | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720112238 | Lawrence B. Blumberg | Otolaryngology | 2359 Twin Bay Vw, Fort Walton Beach, FL 32547-1897 | 2007-03-15 |
| 1598917460 | Donald E Hamilton M D P A | Otolaryngology | 928b Mar Walt Dr, Fort Walton Beach, FL 32547-6706 | 2008-10-22 |
| 1114916756 | William Elsworth Gross | Otolaryngology | 1005 Mar Walt Drive, Otolaryngology Department, Fort Walton Beach, FL 32547-6796 | 2005-10-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447870977 | Shanmugasundaram, Venkatachalam | Otolaryngology | 10131 W Forest Hill Blvd Ste 201, Wellington, FL 33414-6109 | 2020-04-24 |
| 1851910517 | Daniel Oswaldo Manrique | Otolaryngology | 325 Saddle Ridge Dr, Davenport, FL 33896-8176 | 2020-04-13 |
| 1932735768 | Martin Alvin Shugar | Otolaryngology | 3850 Hollywood Blvd Ste 401, Hollywood, FL 33021-6746 | 2020-03-12 |
| 1396219242 | North Broward Hospital Distric T | Otolaryngology | 1801 W Sample Rd Ste 101, Deerfield Beach, FL 33064-1370 | 2019-01-14 |
| 1356811194 | Donald Lee Roberts | Otolaryngology | 4251 Commons Dr W Unit 5211, Destin, FL 32541-8636 | 2018-12-04 |
| 1275022238 | Mary Teresa Garrish | Otolaryngology | 405 Sims Way, Merritt Island, FL 32952-5233 | 2018-05-05 |
| 1437658671 | Baptist Ent Specialists Inc | Otolaryngology | 11236 Baptist Health Dr Ste 330, Jacksonville, FL 32218-2989 | 2018-02-02 |
| 1467970368 | Portela E.n.t., Pa | Otolaryngology | 3100 Sw 62nd Ave Ste 124, Miami, FL 33155-3009 | 2017-08-31 |
| 1427414358 | Rufus Madison Holloway Jr. | Otolaryngology | 1616 Lake Shore Drive, Orlando, FL 32803 | 2016-01-07 |
| 1609253178 | Sumeet Bhanot Md Pa | Otolaryngology | 2038 Bee Ridge Road, Suite A, Sarasota, FL 34239 | 2015-05-04 |
| Find all providers with the same taxonomy | ||||
| City | FORT WALTON BEACH |
| Zip Code | 32547 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.