Healthcare Provider Details

I. General information

NPI: 1063774602
Provider Name (Legal Business Name): STEVEN K. BOOTON, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2012
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
78705-1205
US

IV. Provider business mailing address

720 W 34TH ST SUITE 100
AUSTIN TX
78705-1205
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 Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberG4844
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG4844
License Number StateTX

VIII. Authorized Official

Name: STEVEN K. BOOTON
Title or Position: OWNER
Credential: M.D.
Phone: 512-381-5599