Healthcare Provider Details

I. General information

NPI: 1093740987
Provider Name (Legal Business Name): STEVEN KIRKWOOD BOOTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W 34TH ST SUITE 100
AUSTIN TX
78705-1241
US

IV. Provider business mailing address

720 W 34TH ST SUITE 100
AUSTIN TX
78705-1241
US

V. Phone/Fax

Practice location:
  • Phone: 512-381-5599
  • Fax: 512-323-0307
Mailing address:
  • Phone: 512-381-5599
  • Fax: 512-323-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG4844
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG4844
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: