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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

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