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Jason Boothe
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NPI Number Detailed Information
Provider Information:
Name: | Jason Boothe |
Gender: | M |
Provider License Number If Given: | 32415 |
NPI Information:
NPI: | 1538162722 |
Entity Type (Individual or Organization): |
1-ind |
Enumeration Date: | 5/23/2005 |
Last Update Date: | 7/8/2007 |
Provider Business Mailing Address:
Address: | 4310 JAMES CASEY ST BLDG 2 Austin, TX 78745 |
Phone Number: | 5124167246 |
Fax Number: | 5124166791 |
Provider Business Practice Location Address:
Address: | 4310 JAMES CASEY ST BLDG 2 Austin, TX 78745 |
Phone Number: | 5124167246 |
Fax Number: | 5124166791 |
Provider Taxonomy:
Primary: | 103T00000X |
Secondary (if any): | |
State: | TX |