Individual
STEPHANIE ANN BOOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1301 W 38TH ST, SUITE 110, AUSTIN, TX 78705-1000
(512) 454-3631
Mailing address
1301 W 38TH ST, SUITE 110, AUSTIN, TX 78705-1000
(512) 454-3631
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M1029
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1744773-01
—
TX
05
—
1744773-02
—
TX
Enumeration date
03/22/2006
Last updated
07/12/2007
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