=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063774602
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEVEN K. BOOTON, M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2012
-----------------------------------------------------
Last Update Date | 08/19/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 720 W 34TH ST SUITE 100
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78705-1205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-381-5599
-----------------------------------------------------
Fax | 512-323-0307
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 720 W 34TH ST SUITE 100
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78705-1205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-381-5599
-----------------------------------------------------
Fax | 512-323-0307
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | STEVEN K. BOOTON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 512-381-5599
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | G4844
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | G4844
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------