Provider Demographics
NPI:1093740987
Name:BOOTON, STEVEN KIRKWOOD (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:KIRKWOOD
Last Name:BOOTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 W 34TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1241
Mailing Address - Country:US
Mailing Address - Phone:512-381-5599
Mailing Address - Fax:512-323-0307
Practice Address - Street 1:720 W 34TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1241
Practice Address - Country:US
Practice Address - Phone:512-381-5599
Practice Address - Fax:512-323-0307
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4844174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R66EOtherBC/BS
TX136674210Medicaid
TX00R66EMedicare ID - Type Unspecified
TX136674210Medicaid
TXP01117043Medicare PIN
TXTXB159966Medicare PIN