Organization
VISTA PLASTIC SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTIN HENRY BOOTH MD (OWNER)
(512) 755-8478
Entity
Organization
Contact information
Practice address
4701 BEE CAVE RD, STE 202, AUSTIN, TX 78746-5366
(512) 755-8478
(512) 572-8484
Mailing address
4701 BEE CAVE RD, STE 202, AUSTIN, TX 78746-5366
(512) 755-8478
(512) 572-8484
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1447570916
NPI
—
Enumeration date
10/06/2019
Last updated
06/12/2021
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